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FORoFFI ! sE: K ' -------�a . .............. ��_. )' APPLICATION FOR SANITATION PERMIT Permit No. ._ 4`�1.�?. ----------------- --------------�-------- ------ (Complete in Duplicate) ``� ---------------- This Permit Expiresj Year From Date Issued Date issued .._.. J(_--.. Application is herebymade to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. r This application is made in compliance with County Ordinance No. 549. r JOB ADDRESS AND LOCATION.....---�/ 'sL�-S ------ /'.7wo ..... �1�........................�S�C�.±�/5�7��----•-----..._....-. Owner's Name..... ......... ---••------------•------- �_ ^'Phone ..... Address...--------•----- ' ......4-�-' ------------------------------------------- ------------------- -- Contractor's Name----....._Df.t_/`!_ I-pk'-f.T.1,f.-----y xoov.5--------o!i f+---•-•...................••----••-------... Phone ,6_57 ,l..... I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __.-__ Number of bedrooms _.Z._ Number of baths I---- Lot size ..... PU'kP.i................ Water Supply: Public system ❑ Community system ❑ Private N Depth to Water Table _%;7iS.'�ft. :F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑h Clay ❑ Adobe®' Hardpan ❑ Previous Application Made: (If yes,date---------------_----) No ®' New Construction: Yes ❑ No I9 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ) Septic Tank: Distance from nearest wall____s l2______Dis}ante from foundation____ti p______.Materi I_ /.�',t ..... ..A.u'iC fNo. of compartments--------!_-------------Size_S-76._ ___X_AC _Liquid depth__..._41.0--________Capacity._t �?_ r I i Disposal Field: Distance from nearest well----4�0-----Distance from foundation-__S!?........Distance to nearest lot line._._.>5-...i..... Number of line's------------I---------------------Length of each line-----------?-&-_________.Width of trench._-...... .Z:�i�'�_____________ Type of filter material._-_�-C'��C°_----Depth of filter material_____ 1-----______Total length------------ ....................... Seepage Pit: Distance'to nearest well_____/_Q _'____Distance from foundation---bVP.......Distance to nearest lot line....;5.:_..'_.... Number of pits....../__-----------Lining material__O __.__.Size: Diameter______V_3_."___....Depth.........A:5_..1............ Cesspool: Distance from nearest well-----------------Distance from foundation-_-----.---------.,Lining material__._____----___-___-_---------_------ ' Size: Diameter------------------- ____.De th__--__________-__ __-_Liquid Capacity-* ..... ......gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----!.-.................... ..___..__...... ❑ Distance to nearest lot line--------------------------------------------------------------------••-----_--•-------•------------------------------------------------- t - F Remo�dre�l' g and/or repairing (describe):___l- _�..,•�t.A.__.�.�............. •---- - --f---------------••---...---•-------------------•--------------------------------------------- A f •--•-----------•-•-----.---------- -----------------------------------------------------•-•------------.-------------------------------•----------------. '....................---.----------------------•-----------------•--•-•------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) .---------------------------------------.------.----(Owner and/or Contractor) i ---------------�-------------••-----"---------.._- .... ��—.--- r �fern sy- - ..... -----------------------------------------------------------(Title)-------�a- (Plot plan, showing size of lot, locaelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... x J---i•-------= --._ DATE------` —------------ REVIEWEDBY---------------------- - -- -- ---- ------------ --------------------------------------- ............. DATE----------_---_--.._... ------ ----- BUILDING PERMITISSUED::'............-------------------------------------------- DATE.------------------------------------ r , Alterations and/or recommendationst_ �.--I_-4_ - -----.--......1.-�> _'...... __• .�-��,1 ./ -------------------------------------------------------..:-.---•----..------------------•--•----------------------------------------.------------•--- .----...•--.....-•--•-.....................................--------- . I L ...........................................................:................................................................................................................................................'.................. R FINAL INSPECTION BY: f !! ------`--- -------------- Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streit ow- " 300 West Oak Street t 124 Sycamore Street 105 West 9th Strefl Stockton,California Lodi,California Manteca,California Tracy,California i. E8 9 HEVIIiED a-39 YM 8.951 At LAB - �r t'. �