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FOR OFFICE USE: -M -_-_ APPLICATION FGAR SANITATION PERMIT Permit ..- ------------- ----- --- ---- --------- (Complete .1 in Du Duplicate) ------------------ -------- --------------------- -- --- p' I �-----G This Permit Expires 1 Year From Date Issued Date Issued . __=_�5,_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#a4l the work herein descried. This application ismade in compliance with County Ordinance No. 549. IUB JOB ADDRESS AND LOCATION.. _ _r----AIr�e�.�V---(�. "' �1 F- 1 —27 Owner's Name---- M---------- ------------------------------------------------ ------- --------- ---------------------- Phone-.-?a-./_-__�_71Z Address a - L -----_-- ---,-- I----------------------- Contractor's Name----------------------- ------P'o.:-Ak_mr............A---------- -4 SCJ` -------------- ---------------- Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �' Number of living units: --I____ Number of bedrooms 3--_ Number of baths _I;n- Lot size ___*7_5---X---2 e p------------------------- ' Water Supply: Public system ❑ Community system ❑ PrivateK Depth to Water Table _7-57--ft. Character of soil to a depth,of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z Hardpan ❑ Previous Application Made: IIIf yes,date-.;,._ -------,-,,):,No New Construction; Yes E] No FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: d 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _Distance from foundation- ------Material-__ -.________ ______________________________ ❑�.ls t1 lu6 No. of compartments----------------------- �Size------------------------ -------Liquid depth - Capacity If P - ._l----- li Disposal Field: Distance jfrom nearest weii_��...�____.---;_Distance from foundation_____. ------ istance to nearest lot line____ Number of lines---1-�-... . ........ .. Length of each line�O-__JSJV-2 4W Width of trench.. Type of filter mat,erial �'--------- _- _Depth of filter material___<-_�__-------Total length------/--+�r---------------------- (� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____-__._________ ❑,�&l5-h 416 dumber of pits--------------------- Lining material-----------------=-_--.Size: Diameter.------------ - -------Depth....-.--------------------------- \3 Cesspool: apt ..---.---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------.Lining material..................................... ❑ Size: Diameter ---------------------- Depth = =-------------------------------- - --------Liquid Capacity----------------------------gals. %--r Privy: Distance from nearest well------_-.______.�--------------------_-.-_-!_Distance from nearest building..___-.----______._----------_..__--.--. ❑ Distance to nearest lot line----------- ----- -----------°l.G� y -------- = ------- ----- - Remodeling and/or repairing (describe): ----- -- -- - ------- - -. - --- - - -•---- - ---------••----•--•----• -•---------------- ----------------------------- - ----------------------------------------------------------------------:---- -------------------------------------------- ------------------------ = ------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- y I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Sta a aws, �a ,rules and regulations of the San Joaquin Local Health District. (Signed)----y -----Nion -- ----=----------------------- -(Owner and/or Contractor) t By:----------------- /�`�r�` ---- ---`` -------------------- (Plot ------------------ tTi+le) { (Plot plan, showing size of lot, location of system in reells, buildings, etc., can be place n reverse side]. 3' FOR DEPARTMENT USE ONLY oe7 APPLICATION ACCEPTED $Y = DATE------1--- ----------------- IREVIEWED BY------------------------- ------------------------- -- - ----------------------- -------------------------- ----------------- DATE------ ----------------------- : BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- --------------- DATE----- ------------------------------ ----------------------- Alterationsand/or recommendations-------- --- ----- -----------------------------------------------"-'-•----------- ---------------------------------- ------------------------------------------ -------------------------------------- ------------------------------- - ---------------------------------------------------------------------------------------------------- - ---------------- I r FINAL INSPECTION BY: /---------------- -------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:etlon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 F.P.CO.