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rUK UrrI(-t USE: •.. — ........... ----------------- _- ------ ------------ APPLICATION FOR SANITATION PERMIT Permit No. a_e�..o_a (Complete in Duplicate) 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 made0A1TIONW-. mpliarre-.wi.tb, ung Ordinance Na. 549. ' � 0410 ,.3�JOB ADDRESS AND L Pnx47R55? Owner's Name--------------- VIF?s•---- ED Phone -.2- - ------- ----- ------------------ --------------- ---- Address______________ _o-C------ 1-2-7--------- ------------ Contractor's Name------ .-__A 1.l- : �, # ;�r I Ph� p-------- -•-- --- - ❑ ❑ Trailer Co ❑�yMot I one Other -------- 4 Installation will serve: Residence• A artmeni•"Ho sue Commercial ❑ ❑ Number of Xving units: - ----- Number of bedrooms _ Number of baths _ 6l /��R,Zx ,/ 1 w - L�7 p Lot size ft. - ---- ------- I------------ s1. � � st Water Supply: Public system ❑ Community systems❑ private De th to Water Table Character of soil to a d4pfh of 3 feet-7S66 .,.- Gra'vei ❑ Sandy Loam [] Clay Loam; Cla �. � �� . � y ❑ Adobe❑ Hardpan ❑ Previous Application Made: �I .yes date-..__.._ J-110 � New Construction: Yes ❑ 'No �' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: •+ i`. ovtOffT(.No,septic-tank_oacesspoolpermitted.if•.public sewer-tsavailable_wi+hin,200_feet.) ik" JL - Septic lank: Distance from nearest well _Distance from foundation-------------------Material-__--__._________.____-._-__ s I - � No. of compartments Size Liquid depth------ - ---------- Dispasa# Field: Distance from nearest wall_._� ;..._Distance from foundation____ _ ' ��a.>w -�. ,,;� ._.. l�-________.Distance to nearest lot line--_-s-,-. e Number of lines_______� ___________ Length of each line------ `f•.Width of french-.- ;Z1 �� : "T e of filter material.-� C - ' ---- ---------- yp �- - _-K------De.pth of filter material-__-f.- ------------Total len th----_��-__d- 4c W4 ■ g 1 - Seepage Pit: Distance to nearest well-----54--- from'foundation !___4[7______.Distance to nearest lot line_t�__--- Ist'J Number°of pits.._—_ y- -- Liningrmater�al__ �. __-.Size: Diameter. - — y. :-r*� Cesspool: Distance from nearest well_________________Distance from foundation-,-----___---__----.Lining material___-___-- ___-_-____.!I________ ❑ Size: Diameter-------------------------------------- Depth - ----Liquid Capacity.- gals. Privy; Distance'from'nearest:well-_—_-__rr_---- -� __- __-Distance from nearest buildingp! Distance to nearest lot line.-.----_-.--- it ----------ill__------- --------------- - ------------=--------- -------------------- ------------------------------ Re -----------------•---- -- ------- - Remodeling and/or repairing (describe)---------------------------------- --------------------------------------•------- I -------------------------------------------------- il' ---------------------------- ----------- ------------------------------------------------------------------------------------------------------------- il---------- f I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$ to 1 yvs, and rules and regulations of the San Joaquin Local Health District. I (Sigrid)_--- e-�r7 - - - (Ow �I�!>1�---------- (Title) _ # ZIA r Ile- (Owner and/or Con+actor) tw SY� :_ `_ _ _ _ _ le)--------- (Mlof plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed-o reverse side)-ap ►s* FOR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY---- ----`77t_R...J -------------- DATE----- --f ---------------------- REVIEWED BY--------------------------------------------- -- ----------------- --------------- -- ---------------------------------- DATE----= ------ BUILDING PERMIT ISSUED ------------------------------------------ ---------- A terattons'and/or recommendationsDATE ---------------------- --- ::_--__.___.._ "" ^--- �� r.- • w i� ------------------------ ----------------- ------ .-------- ..,,,�---- „,...„ I� ------ -- - it , ----------------- --- -------- -- - FINAL INSPECTIOE - - --- - ----------- Date_. SAN JOAQUIN LOCAL HEALTH DISTRICT ;F 1601 E.kocelton Ave. 300 West Oak Street 124 Sycamore StreetII 205 West 9tF,Street Stockton,California Lodi,California Manteca,California Tracy, California i F.P.C C7. II