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FQRrOFFICE USE: ------------------- ------ ------------ ---------------- ------------01--------------- -------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------- -----------I------ (C .1 .4 (Complete in'Duplicate)_ `-Date Issued ---- ------------------------------ - ---------------------- This Permit Expires I Year From Date Issued AppliLtion is hereby made to the S6n Joaquin Local Health District for 6 permit to construct and install the work hen described, This application is made in compliance with County Ordinance No7. 549.sit A , ,V jr _F—------oF----Pap, I-D.. ....... its L-0 -A,rJO8'eADDRESS. AND LOCATION. t 00-P e Vj�4:0. I Aj Owne��Name------------- ------ -- ------------------- ------------------------------------------------------------- Phone.---4 Address hone------ Address........ I ----------------------- ._�----------------------I-----------..... ... ------------------ J .. . Contractor's Name-.__.....0-W.4_ P_.•........11, 1 ----------------------------------------------- ----------------------------------------------- Phone..-- ------------ Installation will serve: 'Res"�fdence 'Apartment House E] Commercial El Trailer Court (:] Motel El Other. E] Number of living Ynits:V $I - k- .Nu rber of bedrooms 3/Num er o bat.. size ------ ---- -S--%_AaWafer: Supply': Publicsstem Community system [-]jRrivate 2�'Depfh to,4ater_jab�lsj I A ------9 Character of soil to a depth of 3 feet- ��ancl El Gravele ,E] Sandy Loam o Clay Loam R--Clay Adobe Hardpan Er"'_ Previous Application Made: (If yes,date.....___,__A------)/No [ New Construction: Yes 0--No E] FHA/VA: es No E] If # . TYPE OF INSTALLATION AND SPECIFICATIONS.: (No septic tank or cesspool pe Se 4. ' rmifted,if public sewer is available within 200.-feet.): m nearest q—qce from found n--.-- PC T nk: Distance fr `-Z o' - 5t- - atio"_ -------- -7 --- - -------- No. of compartments---.-, -------------- -___Liquid dept'h_-WA-. —--------------C,p,1its____.__-__-4MP_ om nearest well Disposal Field: Disfance fr �V Disfrom foundation----1.0.1-__-Distance lo to nearest jt�line............. Number,of lines.j,_____________________Length ngfh� of each line------6 Width of french------ -------------- • pit. Type of filter ni'a'Otoerial---RiQi_c,_-_k4N.___Depfh of filter material------1'7_ 'tJ --Total length-----------9AF ------------------------ I Seepage �rNDisfance4Z nearest well...//40 44�-------Distance from foundation--/jO--------- Distance to nearest —----- ber,t I of pits...- -------Lining maferial__RO<-K----Size. Diamefe#r__,� ...q-----Depth---.,1 -rte Cesspool: Distance from nearest well_.-_-------._._. 1-1. ------------ ---Distance from foundation -------------------- Size: Diameter--- I --------------------------------Depth----------------------------------------------------Liquid Ca .pac -------- -----------------gals. Privy:l Distance from nearest well_____________________ --. _-,_-Distance,from nearest building----------- ----------- ❑ Tj Distance to nearest lot line---------- ------- ------------ Remodeling and/or repairing fdescribe):------5)(6ZE-EA-4------- 9.1 0 pm _t--- --------- ------------------- ----------------- -----------JIVS-7.A.4_44�=_D------ -- - ---------------------- -A--------- - --------------- - ----------------------------------------------------------------------------------------------------------- -----------r------------------------------------------ - ---------------- --------------------!�-- - ---------------------------------------- --------------------------------------------------------------- --------------------------------------- --------- --- -- --- - - -- ---------- " I a herb%y certify that I have prepare-d +his application and that the work will done-,in"accordance with San Joaquin County �I: State laws, and rules and"regulations of the San Joaquin Local Health District. Sgn d)---- -------------- i --------------------------- -------------------------------------------------------------------_(Owner and/or Contractor) By:------------------------ - it --------------- A A I - ------------------------------------------------I-----------(Tif le)---------------------- ------ ................ ..-,_(Plot plan-, showing,size ofjotjocafio�t n of system in relaf;on to wells,,buildings, etc., can be placed on reverseid e). T FOR DEPARTMENT USE y APPLICATION ACCEPTED BY-------- --- ----------------------------------------------------------------- DATE------- RV ---I----- EVIEWED BY - -------------------------- -------------------------------------------------------- DATE ---------------------------------- BUILDING PERMIT ISSUED-----=- •---1----- ----------------------------------------------------------------- --------- DATE-------------- Alterations ------ ------ - ---------------------------- and/or recommendations:_-_--- I -1ka h ;h�------------ ------------------- ------------------------------------------ ------------------ ---------------------I-------------------------------------------------------------------------------------------------------------------- ------------71-7----------- --- ------- --------- ------------------ ----- ---------------------------------- ---------------------------------- ------------------------------------------------------------------------------------- ------------------------------- ---------------------------------------- ------------------------------ ---------------- --------------r ---------nIA 11 1A --------------------------------------------------------- --------------------- FINAL INSPECTION BY:---,& -------�------------------- IAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California