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FOR OFFICE USE: ----------------------------- ------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ___ ---........ ------------------------------ �'J�y�,�`-.----,-,---------.;,:. (Complete in Duplicate) f /_l •FU(SE_,-_ E -!'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 comp iance'with County Ordinance No. 549. AC JOB ADDRESS AND LOCA O __ N-- --- ; _rNRF� ---- -- ----- _{}/ CVP1�_____.P ------ CCI Owner's Name e' .t.AtF6-J::___ _ _ '?----------Co-"------------------- ----- Phone----------------------------------- Address........... ----------�Q-Y------- ='�'�`�`",t "". - =r AT-�-=-`--��--------•---- -- -------------------------------- Contractor's Name_ .__ 'PT�_� _.TJ`�1'S---- R \I_II" <--_r---- 1 #� ,P,h'wi:N �1Z Installation will serve: Residence] Apartment House E] Commercial Trailer"Court ❑,.�•M;' el ❑ Other ❑" Number of living units: ___-____ Number of bedrooms _ __ Lot size Water Supply: Public system ❑ Community system ❑ Pri ate ❑r Depthhto Wate.�Ta { PP Y• r Table _ ft. Character of soil to;a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam 5K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous A licat'on Made: 1f`�es,date_'_ _______________}. No New Construction: Ye ... � : 1 4 PP 4 Ys� ,. s R '•No [] I FHA/VA: Yes No . t -.�:-�- TYP-E OF-INSTAL-LATaON ANd..SPECIF[CATIONS. ..�= � =- -_= - - -T-- =_jt. - ---� {No septic tank or cesspool permitted if public sewer is available within 200 feet.) r . �:rMaten -- - , Septic ink: Distance frosY�.-nearest well- .. 0 _ Distance frodm foundation r__ _ _ No. of compartments______.2-_____________Size_3_ __-f-'K7Liquid de.gdiy_' fit-----_-Capacity____ Disposal Field: Distance from .nearest well-.-.50___-Distance from foundation__` _ f _.Distance:to nearest lot line_____.- : �. .` Number of lines__ `__ -----------------------Length of.,each line_____:, Q_._ VC--.WidtMof french__ t� -0 Type of filter material__P_0. J _ Depth of filter material__._. _ -Total Length_______________ � _ Seepage Pit,: Distance 'to nearest well------------_---------Distance from foundation_____..---------.Distance to nearest lot line- -� ❑ _.____-___- '., Number. of pits---------------------Lining material----- ----------------Size`Diameter---------------!-- ..__;Depth-----------------,---------------- ^ ti rF r„ I Cesspool: ., �. Distance from nearest well____________-----Distance from foundation___ __-_-_.__- .-.Lining material____-.- '"__-____:.___ �. ❑ Size: Diame'Fer. - ----------------- ----Depth------ ------------------------ -------------- Liquid;Capacity-------------- "-=---gals. Privy: t Distance from nearest well---------------------------------F------------._Distance wfrom nearest buildin ❑ Distance to nearest lot lire---------------------- ---------- --------------------------' ----------------------- ------g------------------------=a",- ------ ® !. i. i .,- l 4 �r� • .y Remodeling and/or repairing (describe}:....A1d----ItVDI�! +�___I/V --____-_� 1�?1_ _� ' 'fir M1 � ----- { F i - 5 �•• _____________ ________________________________ ____ v-------- -------------------------_------_-------_-------_______---------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accords with San Joaquin County ordinances, State laws, and>r`ules and regulations of the San Joaquin Local Health District. (5ignedl �r. `? ------------ ----- - - i rrt ¢ - .{Owner and/or ContracterJ - - -------- ------------ - - (Plot plan, showing size of lot, location of system in relation to wells,'Isuildings, etc, ian be placed on reverse side). i r FOR DEPARTMENT USE ONLY f- ----------- APPLICATION ACCEPTED BY =O'- - DATE-------- €�_-7--1. -�''- �` ' : REVIEWED BY----------------------------------------*'-`---- ---=---------------- ---- -- -------------------------------------- DATE---- ---------------------:----------------------------- BUILDING -------------BUILDING PERMIT ISSUED-------------- ---------- ----------------------------------------------- DATE-------------------------------------------t ----------- Alterations and/or recommendations:------- rf1ii9 - -` --------------------------------------------------I------- F ----VAN'T'F—:�-I>---------40_ _'co_f.1-------4�-----TA.N-r.......C1HMAGn ----- T�------Aa . 51401& -------- z-A __171`7 ------- I(- 1177.1---- .<------ - ---=---- -------------------- -------- ------------- --------------------------------------------=--'---------------- F€NAL INSPECTI9AL.6=1j-��_ -s Date----------- ;✓ --------- f SAN:JOAQUIN LOCAL HEALTH DISTRICT - 1401 E.Haielton Ave. 300 West Oak Street ry 124 Sycamore Street 205 West 9th Street Stockton,California r Lodi,California) Manteca,California_ Tracy,California