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r%-wr,, vrrlLCUJC: n. . ------------------------------ - --------------- ----------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT t Permit No. ...� U -- ----------------------- - ------ -------------------- (Complete in Duplicate) t ------------------------ � !�Date I55Ued This Permit 1 Year From Date Issued sari-- Application is hereby made to the San Joaquin Local Health Disfir'ict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance NV549. JOB ADDRESS AND LOCATION___---------------?Q--5 -_ - •? Owner's Name___._ �+ ---�- q- ---t�-!�-1..�:��.----- ----�QIY_ 7.7`x. co- t"-�--- ----------- -- ---------- '-... Phone-------------•------------- Address i4r-x....BOX---: �Q� Contractor's Name___________ ___ __ nl)LT-111- ------------------------------- -----•---�---•------- ------------ --------- - -- ------------- Phone B -----------••-----••------•------- Installation will serve: Residence �Apartment House [ICommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms 13._ Number of bath sf � Lot size _------ye _ � __ ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table J0._ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 01 New Construction: Yes ®r*'N—o ❑ FHA/VA: Yes ?7'--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ :._ 4,(No.sepfic tank or cesspoo`I'permifted:if.public sewereis avatlaFile wi}hin 200 feet: ��d / ,„ Septic T.nl ; Distance from nearest welltvl1__'_Distance from foundation_._l___.__._-_-_.Material-_ IV T F ? A Rtr .,,, No—ofrcompartmegts__2 �:__ Size_: X I x Li. uid de th__.� ° f q = p? -=2 ---Capacity------ - Disposal'field'.-•--- Distance-from-nearest•weil:-<::.-W.--Distance-from*foundation__�+0 -Distance-to-nearest lot line -S ------- Number of lines- ----------- -------------------Length of each line------ - i ,-- .Width of trench._-_�_36____r - Type of filter material-__ QDepth of filter materiai_._.�_ _____!�----Total length___-_.___`a ---------__ t Seepage Pit: Distance to nearest well----------------------Distance from foundation-------__ ----.Distance to nearesfilotlirae:_-___ ..____._ , ❑ Number of pits.- ------- --------Lining material------------- --------Size: DiamefJ------_---- De th_ -=�-__-_ =,---_'----___--- p 0 Cesspool: Distance from nearest well-=____----_..._ Distance from foundation...._._._._:-_ H - ___.Lining material_�...'"k_ w. � ", Size: Diameter__.--1_-- ___--- Depth .__ ------------------ Liquid Capacity gals. Priv - __:.-Disfance tramneares.t,*-buildin g =--------------- - ❑ Distance to neareatelot lime.- -_.- repairing (describe)_____________ Remleling __or __ I :lr --------------- ---------------------•----------------------------------- I --- ----- ----- ---- - --------------------------------- - --- ------------------- --- ------------ --------------------------------- '"-- ------------- —:-+ , J4�s"°"�1 + i r `---'--------------------------- -- ---- ---- -- ----- -- r ----------------- I'here6y certify that I have prepared this application and That the work will be done in accordance with San Joaquin County ` ordine'ttces, State laws'and rules and regul fion# of the San Joaquin Local Health District, i f (Signed)---------- ! ---'' r (Owner and/or Contractor) I sY� --- ----- ---------------------------------------------� �r ,..� .•_ --- -'---Tifie)---- ------- ---- - (Plot plan, showing size of lot,lot,�locat on of wsysf� in relation to wells, buildings, etc., can be placed on reverse side). F I I FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--- - R,f0 DATE. --- ------ - REVIEWED BY - I � � L— -`-- �----- DATE BUILDING PERMIT ISSUED ---- DATE_- .;--:.-:-_=-------------- - --------------------------------------- _._ .. . ons and/or recommendations:.*:---------- ___________-�_ � _ terafi - _ _ ------'--t------'-----'•---•-------- ----'----r -------� - -------------- Y - -- - __ - - ------ - . -`� - - --- == ----------------------------------------11------------------------- -----'- -- -----�=------- �'. -- — ---------'----'- - ------- -- FINAL INSPEC B �( - Date-------- ----- SAN ---SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.CO.