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APPLICATION FOR SANITATION PERMIT Permit No. MComplete in Duplicate) JJ 7 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. 1 4 r . JOB ADDRESS ANDY LOCATION___�-VQ_RT 1---5j[�I�---e--'--- NI_JN-: --- -00<----w�5 --- --- EF�Y Z ---- -'- ---- Owner's Name ,1b1NN----_-Of)-RFL _vN--------------------------••------------------ --------------------------------------------- Phone------------------- w' Address------RTS-- ----------_OX-------73-0---- � Contractor's Name---------0_�UN -------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___- Number of bedrooms __2-_ Number of baths /_____ Lot size -------50__K_1_} ------------------------------ Water Supply: Public system M' Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No R' New Construction: Yes E( No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: "(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 3i SepticYank: Distance from nearest well__ 0-__-_-__Distance from foundation___ f_-----------Material---Kj_t*Vro No. of compartments ____ 2� p -----------Size-.- ---- -�-�---i--------Liquid depth------- ---------- -- CapacitY----f�-�7-�'�-------- � Disposal Field: Distance from nearest weli__5�_______._Distance from pErfoundation___I-C__-__r____-Distance to nearest-iot-h/e____ �- ____ Number of lines__________ _ ___________________Length of each line__'?_`�_ �______-Width'of trench-( Type of fi{ter materialT".........Depth of filter material____./X_--_________Total length-------- _____ __________ _______ Seepage Pit: Distance to nearest welf---4_�__-_____--_Distance from foundation-__�s`?_---------Distance to nearest lot line---`1 _______ 1 [� Number of pits-------t-------------Lining material-___P*<-K----Size: Diafmfer__S �-¢ � Depth- fi'--r- -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material-----_____________________----_-____ ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--' ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from .nearest building------------------------------------------ F Distance to nearest lot line--------------------------------- ------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------•--------------------------------- t ----------------------------------------------------------------------------•-•------------••------------------------------------------------------------------------------------------------------------' I here6y certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, l (Signedd) , - fJ_ ---------------'---------------------------------------' ---------------( wner and/or Contractor) , By:----a --------------- -----------------•--••------------------- ----------------- --------- -----------------------------------(Title)---------- ----------------•------------------------------------ 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___7T " -------------------------------------- ---------------------------------------- DATE---------- REVIEWEDBY------------- ---------- ------------------------------------------ i ------ - --- -'---------------------- - - - --------- DATE----- - ---•----------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations------------------------------------------------------------------------------------- r•- P1_P 1 NflR_Q> Q lKe-moven--------RDS.-------�------D_V.C�------jW-------DUT- -c-ti--------•442 --------- -----•---------- ----- ---------------------------------- ------------------------------ ----- - -- -- - FINAL INSPECTION BY:. I K-o--'----------------------------------- Date-------------- L�,,{{ Sy SAN JOAQUIN LOCAL HEALTH DISTRICT { 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California — Manteca, California Tracy, California E5-9-2M Revised 1-57 F.P,CO.