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r,UK UWCE U_rF, R: ------------------ ------- --------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------------- ------------------- -- --------------------------- - - -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to%the San-Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliarice with F ourif Ordinance No. 549. SC )�0 JOB ADDRESS AN LOCATION/i _ G�1 --------- 4im- =-----1-2,a? N.Fr� ._ 9 � Owner's Name-----lrl.- N.> J� � P - Phone h Address C L( /� _ �^�_ o Contractor's Name_0W.N-E _(_�'"''-� - ------ -K� bi_� � --- ------ Phone-- _ ' �" ------------- --- r7`TE- 2 eX 2fca(� .�G�I�--- Installation will serve: "Residence ❑ Apartment Nouse Commercial ❑ Trailer Eaerr# Motel ❑ Other ❑ Number of living units: _#_____ Number of bedrooms ___- - umber of baths _1-____ Lot size _-A<—R_�.J��_.�-.----_--_ Water Supply:+Public system ❑ Community system ❑ Private �laepth to Water Table�r5_ ft. Character of soil to a depth of 3 feet:-Sand ❑ Gravel ❑ San y Loam ElClay Loam Clay E] Adobe E] Hardpan ff-- Previous Application Made: If yes,date..........._--------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No Q/ i TYPE OF INSTALLATION AND SPECIFICATIONS: `(No sepfic tank or cesspool'p miffed~if'public sewer'is available-within-200•feet.) - -- Septic k: Distance from nearest well___5 --_Distance f om fou`ndation_____� ---------Material-___CQ^ifCR_F__r No. of compartments____T�_____....:_Size�_x_�__X5_-"-_,___Liquid depth__ '-�--------Capacity___ _ Q-_-- Disposal Field:, Distance from nearest well-SO------ from foundation----- Distance to nearest lot line._____._____ Number of lines______._2________________Length of each lineyou_+__�?�jj �------Width of french____.J�_t Type of filter materiaL__94f��___-_Depth of filter material____.r_-.f__-.__.__-_Total length--------------------{=p-------------- Seepage ----__" Seepage t: Distance to nearest well-1 e9.--------Distanc from foundafion--1 ..........Dista ce to nearest lot !' e_ ^____.- E Number of its.._.__ /______________Linin material_ 0-C X p f 9 � -r�----Size: Diameter_�_��------ Depth------��.--- - ------- Cesspool: Distance from nearest well________ _____Distance from foundation-----.___-----------Lining material---__-...___._____._..__-.__-------. ❑ Size: Diameter--'-------------- -----.Depth------- ---------------------------- ------.Liquid Capacity------------------- --gals. Privy: Distance from nearest well------------------------------------_-------_-----Distance from nearest building__..______.___-_._________------------_- Distance to nearest lot line ----- -- e p - Remodeling and/or re airing (describe} s ---- 5-- _RT'�--------- - ��-f C _ Q p l`y._r1-f-- r -- -------------------------- -- ------------------- ----------------------------- i - - --------------------------------- ---------------------- -- ----------------------------------------=----------------------------------------------------------------- ---------------------------- • rl hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-.laws, an les an r ulations of the San Joaquin Local Health District. (Signed) ---------- - ------------------------------- (Owner and/or Contractor) -- --- -- . . ------. �. .� x_�` .. o f or Y _ --•---=--- ------------------------ �" ------------ {Title) - "` .,.� ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY c.-R +> - -------------------`------------- DATE------ REVIEWED BY------------------------------- I DATE ------------------------ ----- ----- '. BUILDING PERMIT ISSUED DAT=E Alterations and/or recommendations:_ 1 --- -. ----6T_A_KT_-_____Ff :_h___.� - F_ .. Lc`T�__-___ t3-� 31--N--__ .---- _ r_sG--------- -------- mak Qn - =� r-- -©-TE-----' 1_5. ------------------- - --------------------------- ---- -- -- -------------- -, - -- ----------------------- • ------------------------------- ---------------------- FINAL INSP CTION - Date---------L. ----- n SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeilon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9 Stockton,California Lodi,California Manteca,California Tracy,California { F.P.CC.