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�. vF:rR'U UJr; -------------- APPLICATION FOR SANITATION PERMIT Permit No. .4 77- --------------- -- ------------ - --- -------- -- (Complete in Duplicate) - This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permitDate Issued _ /- scribed, "-_ This application is made in compliance with County Ordinance No. 549. : _ . � 5��n ~Z7 to construct and ins#aN the work hereidescrib JOB ADDRESS AND LOCATION._ : le961 LON Owner's Name WA�;- Duvoi,-------- J1 ----.--_ y<= ►=1 = I4 �� _. = �• t - °� '---------- Phone Rom- Address--------- ._ �_ " _ � •....z , Contractor's Nameli.' _>Z. Th . ❑ p Installation will serve: Residence Apartment House [j Commercial ❑ Trailer Phone_____________________ Number of living units. _ ' ) `��'� (� Motel ❑ Other ❑ "--3 Number of bedrooms Number of baths __�___ Lot size _-!I_Ciiz_E_A Wafer Supply: Public system ❑ C_ommunit s s em ,�/ �.. 0 Y Y )❑ _Private L►�' Depth to Wafer Table ;7 ft. Character of soil to a depth of 3 feet:• Sand )Gravel!❑ Sandy Loam ❑ Cla Loam I y Previous Application Made: W yes,da#o_ ._)--------------- t I y ❑ CIeY ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND 5PEClFICATIONS: }) No New Construction: Yes ❑ No /FNA/VA: Yes ❑ No [ t _ (No Septic.tank or cesspool perrrritted if public ssewe r.is_available+rithin 200 feet.) f Septic Tank: Distance from nearesf vreiL__ -C}_____ _ _ - .. "'. , Dist,ncetrom foundation_-__ ------_.Materiaf_._ fli� I��7- -_ No. of compartrrients____ - ~ �. - - Size- - -------Liquid depth r( Disposal Field: I " A l j 41- ---------------Capacity---__•" ____'_______ 1 Distance from nearesf well_.-- _� Distance from. foundation____ ' .'____._Distance to nearest lot line_____ • Number of lines--___r5-_�E /f-- _ -. _ fA*:;.. , --'ti._Le"�gth..ofne{ach line------ .6 3V------- ------Width of french.---3,4 - Type of filter maFerial_ � G `,pepth of filferrnaterial "--_-- Seepage Pit: -----Total length---------------------`-�a-o--------- Distance to nearest well_____"-_-______-_ _lbistance from foundation�w::--------❑ Number of pits-______ --,_--Lining material--------- �K' .' Distance to nearest lot line"____--_----- -- -" -Size: Diameter_ .------------- -- Depth ---""--- "' l Cesspool:- �' A°"Dli fance`YGr nearest w' _ i PrivyE i 3 3; 4Si e. Diameter-_['_.-__d_._....N-----------------6epM Distance from foundation---------- --- Liquid material _._------- ---- ----- e from nearest v✓ell___"_ Capacity ga s. k ------------__._Distance from nearest building � ❑ .1 IDistance fo nearest lot line----------------- g----------------------- ----------� - --------- --"------------------------------- ----------? Remodeling and/or repairing (describe)________________ _ . --------- ---- r ----------------------- ------------------•--------------------------------------------------------------------------------------- --------------------------------------------------- , ------------------------------------ --------------------- ------------------------------------------------------------------------ m ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the. San Joaquin Local Health District, ,� (Signed)- --- ----- B _ =-------------------------"................................................"---'-. _(Owner and/or Contract BY:----------------- ------------------------- ------------ - ---- -•-----------------------------------------------------------------------------------(Tit (Title) ....... "-- .. .---'- ---1 •r(Plot.plan, showing size of lof;;.location-of;system in relation to-wells,-buildings, atc.,-can_be_placed.:an_reverse_side)._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYa -_-- REVIEWED BY -------------------- -------- ------ -�-------------- - - - - - ---- -------- ------ -------- - -------- DATE BUILDING PERMIT ISSUED - DATE__.----- ------------------------------N Alterations and/or recommendations:. ----------------------------—-------------------- -- --- --------- DATE----------------------------------------------------------------- ___"____. ------- ----------------------------------------------------------------------- - = ------------ -------------- ----- --------------- FINAL 1NSPEC ----------- - Date--- ------------- SAN -----------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca',California � F.P,CO. 1. Tracy,California �.rr••*"m^^ +1;J Ir �a