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'FOR OFFIC�` ---- -------- 0 ------------- ------------ AOTLICATION FOR SANITATION'PERMIT Permit No. 1.9�-A -------------------------------------------------------- -------------- -- (complete in Duplicate) Date Issued IP--'> ............................ ------------ -- This Permit Expires I Year From 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 made in compliance with County Ordinance No. 549 ------------------------------------------;-.. ---- ----41 ."JOB ADDRESS AND LOCATION------17��).... ------------ 04,5,(4 �0 d I ----K-A - A - ----------------- Owner's-Name-------------- ... .. Phone-- Address---------------------------- -- --•-13-1--------- - ----------kf.,05�lq------------ --------------- F ----------#-"- - 'Contractor's Name---------------------- �.s---------------------- --------------------------------- ------------ Phone" 160allaflon Will'46rvt): R-esi'de-'n"ce'%:,Apa-r'f-i-n-e-n�t House ❑ Commercial E] Trailer Court E] Motel [] Other El N'Go�beqr obliving units: NuM'r6r of bedrooms -7- Number of baths J----- Lot size --1.!3-.L--1----------NO------------------------- Wafer Supply: Public system Community system El Private F Depth to Water Table -------- ff. 'I fti a d Sandy Loam E] Hardpan ❑ 'Character of Sol depth of 3 f SaAVCI� Gravel 0 Clay-Loam Clay Adobe Previous Application-Made:-(if yes,date-J-'-'----) Noj&, New Construction: Yes)<, NoE] FHA/VA: Yes ❑ N TYPE OF:IINSTALLATION�AND SPECIFICATIONS: (N, tank of cesspop)permiffed if public sewer is available within 200 feet.) .9 septic pfic Septic T k Dislance4fro'rt!iFnearesf4well---I D*,,t,nj;q fr ,found-Ofion----- - -------------- ---------- -------- -- •------------a c.fi..compartments------- Liqid ci,p*-�6- Capacity-1........... V- a ----- - - Ir 4: Disposal Field: 01419nce from neare§lwell...1!rn......Distance from foundation-_-/-7---------Distance to nearest lot lirie--P..... zbumber of hnes-------(F- %S7 •-------Length of each I)blo---617-2-051width of trench---,;W�---------------------- I ly-PE -f"Ate matj�l T "o ia 14 --Depth of filter material___1-t-) -------Total length-----------/-&-o---------- Seepage Pit- Distance to nearest well-----__----------DiStanc e fro po fou lidafion----1.7---------Distance to nearest lot Number of pifst:--72-- ---�-------Lining material---a--(Zillt-Size: Diameter___-----a-,a ------Depf h----a-V------------------- Cesspool: Distance from; nearesf well-------------- --Distance from foundation---A----------------Lini ng material-_____-____---_.._.____.____________ E] -::Size:-Diameter------ -------------Depth----------------------------------------------------Liquid Capacity----------------------------9a as. Privy: Distance from nearest-we�l --- -------- -----------------------------------Distance from nearest building_.___.-.___________----------- F-1 Distance to nearest.�lo <1,r7e -------------------------------------------------------------------------------------------------------------------------------- ----- ------------5 ------------- Remodeling a nd/orfriepa i ring (clescribe): ------ --6 .1- ----------4' --------------- ---------- - ----- --- I ----------------------------------- ------------ ----------------- ----------------------A- --------- ---- - ------------------------------------------------ -----------------4-1-----------------I——------ ------------ ------------------------------------------------------- ------ ------------- ...... ------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------------- ---------------------- I hereby certify that'Iha4l prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and nd regulations of the San Joaquin Local Health District. 0'2-!4Lt 5 4- A..I---- ---- ---------- --------------------- (Signed)---------- ------------------------------- - - -------- (Awner and Contractor) (Tifle)--61�11'�- -- -------------- By------------- ---------------- --------------------- ----------- . t --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARPENT USE ONLY APPLICATION ACCEPTED 13, _. --- -------- ------- -- - -------------------------- ------------ DATE--- BY---------------------------------------------------------I-------------- - --------------------------------------------------- DATE---------------- ---------------------------------------- BUILDING PERMIT ISSUED--------------------------------- ----------- --------- ------- ---------------DATE --------- Alte�ra ------ ----------------r---------- -------------------- ,#f!ons and/ r reco .20afions:--------- ---------- Tp -------------------------------I-- - ---------- ------------------------------- ------------- ------- -------------------- ----------I-------------7--------------------------- -------------------------------- ----------------------------------------------------------------------------------- ------------- ----------------------------------- --------------------------I----------------------- -------------------------------;---------------- ------------------------------------ -------- ----------------- ------------------------------------- ----------------- ------- ---------------------- ----------------------------------------------------------------------------------------------------------------- ----------------- Y. FINAL INSPECTION -- - -- ------ ---------- Date- -- ----------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P4Q. jF