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FOR OFFICE USE: e-II&k..................../.d. -.0...... ............ APPLICATION FQR SANITATION PERMIT Permit No. ................... ........... .. I -2 ............................—:.................... (Complete in Duplicate) All.....................------------------------- This Permit Expires 1 Year From Date Issued Data Issued Application is hereby made to thii San Joaquin Local Health District for a permit to construct and install the work her derribed. This application.is made.in c=opliance, wifh.County Ordinance No. 649. 6 .4 W 004) W_� Ifft,14.le - - JOB ADDRESS AND ....... ........ Owner's Name.. A1A..d1-&A.PA7.49/---. . .. ........ .......................... Phone._..—.—..................... .............. * / —.......................................................... -X.......a-*-x...../0 . ........... Address.. 4....... Contractor's Name........A-120... ........... --------............................................ Phone.............._........._....... Installation will serve: Residence Apartment House [3 Commercial [] Trailer Court C] Motel 0' Other [3 Number of living units: ./.. Number of bedrooms .3.0.e- Number of beths,3.. Lot size ......................... Waterl Supply: Public system C3 , Community system 0 Private QW'Septh to Water Table .7.."ft. Character of sag to a depth of 3 feet: Sand[3 Gravel 0 Sandy Loam fflClay Loam 171 Clay [3 Adobe 0 Hardpan Ii Previous Application Made- (if yes,date........... I No j?^ New Construction: Yes 9?'-No EI FHA/VA: Yes R�^No C] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance frorninearest wellZA9AP-O'Distance fr m foundation............ No, of compartments.... ................SizeZ...."u?.Liquid depth...4................Capacify.2 t� ei Disposal Field: Distance from nearest well ZX90--Distance from foundation.ZP........ Distance to nearest lot.line---e&....� I� Number of lines .17. Length of each ...Width of trench--- ................ ........ 'r Type of filter materia- of filter material—,4P`�'.---Total length.. -3.Z,,4......._.__........ Seepage Pit: Distance to nearest well......................Distance from foundation...................Distance to nearest lot line................. Number of pith-....................Lining material......................Size: Diameter..--.................Depth-............................... Cesspool; Distance from nearest well...............Distance from foundation....................Lining material................._......._........_. Size: Diameter-.................---............LDepth....................!..............-...........Liquid Capacity..............._..........gals. I Privy: Distance fmm[ nearest well_...............................................Distance from nearest building..............-................. 0 Distance to nearest x % earest lot line...-........... .........................—.........................—...................... 4e Remodeling and/or repairing (clescri ...................... .1 . -15X- -5-2!9 ..... ....._-._...._---...------....._------.....I-. . ............ ................ ... .....................-----.........-..:-•.:- .................................. .......................................... ........--.................. . -. ..........-.................... ................................. ......................................... ................... ........................ ....... .............................. ................... I I hereby certify that I have'�prepared this applicaiion and that the work Will be done in accordance with San Joaquin County ordinances, State laws, andel nd ruleiland,regulations of the San Joaquin Local Health District. - --------------- - ------1-111...........—.................Mpafe"A4W Contractorl (Signed)..-----........4., #, . ....................... By.—.............................-......:.. • "-s�............... ........ (Plot plan, showing size of lot, location Sys�Am relation +0 wells. buildings, etc., can be placed on reverse side). !FOR DEPARTMENT USE ONLY AfIRILICATION ACCEPTED BY..�.�!...............i.. ........................................................... DATE....-f. -k.(i..-----'----------+---.. REVIEWEDBY--------------_.....—.-- - 1....... ..........---................................................. DATE.............................................. ....... ..1DATE.-------..........................--'-'--........._ BUILDING PERMIT ISSUED........_...... I ............. ...................... .. ............... ..... .... Alterations and/or recommendations:1........ ------- .................................--..........-........I....................................................—:�!.... .............................................................. ............................................................................................................................................. .................--...............-.1-................................................................................—...................................................................7...... ....... .............—............................................................--......--......................................................................................................... be .........................................I..................................... .............................................. .............. .................................................. ............ . ... .. FINAL INSPECTION BY:...C��... . .................... Date..... . ..... ............ • SAN JOA9UIN LOCAL HEALTH DISTRICT 16016."apslion A". 300 West Oak sints? 124 Syc...r.Street 205 West 9th sf,ost Stockton,California Lodi,California t Monfac.,'California 7,o,y,C.106'.1. F.P.MO.