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FOR OFFICE'USE: --------------------------------------------------------- r APPLICATION FOR SANITATION PERMIT Permit No. m Coplete in Duplicate) Date Issued �_7__ This Permit Expires 1 Year From Date Issued 3 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. .- WJ4/ 1Tl�iz/�- JOB A DRESS AND LOCATION..I V. C �-------- - Q (._1� C i _ J�5 _r. Owner's Name----------- --------- -------- -- ---------------------- --------- ------ Phone--------------------- -.. Address-------------� --------AlPFF T------------1�3._v:�----?--•---------------------------••---------------------------------•----------•-----•------ Contractor's Name------------0 LVN f��------•-------------------------------------------------------------------------------------------- Phone---------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other L _ y� 1 Number of living units: --I--_- Number of bedrooms —Number of aths ---Lot size _____..._��!.____._ -�--`-' Water Supply: Public system ❑ Community system ❑ Private R Dept hRto Water Table ft. Character of soil to a depth of 3 feet: Sand�'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan;l❑ Previous Application Made: (If yes,date--------- ----) No E4--New Construction. Yes fEg--4o ❑ FNA/VA: Yes ❑ No;1Q� TYPE OF INSTALLATION AND SPECIFICATIONS: i 1, i septic f rtk or.cesspool permitted.if•public sewer is available-within 200 feet.) Septic Tank: Distance from nearest well Distance from foundation__.�Q_-----_-.Material_ Material +�'QNC�_____T�—�� ®� No. of compartments-_- --___. ...._Size__�_..x_1�__X - W_Liquid depth- ____..Capacity___I_Zp_a,_ Disposal Field: Distance from nearest well..: -----Distance from foundation--- _____-.-.Distance to nearest lot line--- 1 �» ,Number-of lines------------------------- ._,Length of each )Fine___`� -----------------Width of trench----- F ' Type of filter mate rial'--RQaK--_Depth of"filter material----��---- Total length__--------- -------- ------ r Seepage Pit: Distance to nearest well-'�Q- -----Distance from foundation--_-_td--..-__. ista e to nearest lot line-___ ___a Number of pits--------- _ -_Linin material__90_<:K . Size:•Diameter_ _De th--_9_."-_---_--_ . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.___...-------.------_----_-:I_____� ❑ Size: Diameter------------------------------------.Depth-------' -------------------------------------------Liquid Capacity-.-------------------------g3als.� Privy: Distance from nearest we]-------------------------------------._'-----------Distance from nearest building----------."-__------_---__---_.____ ❑ Distance to nearest lot line_________________________ ------------------------------------------------------------------------------- ----------------------------- i ---------------------------- i Remodeling and/or repairing (describe):-------------------------------- .-__._.______--_ -------------------------•------------------------------------------------------ - 3 t F `` 1 ------ -----------------T--------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count) ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- --------------------------------------------- ---------------------------------------------(Owner and/or Con#ractor) ----Title_--- --- Y __ I ) "J (PEot-plan, showing siie "lot;location of syst m in relafiori to walls;buildings, "etc, carr be'placedP I. FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED°BY--?-'-1--='-- ------------------------ ------------------------------ DATE------ REVIEWED BY -- -- ------------ - ------------------- --------------------------------------------------- •- DATE------- :; BUILDING PERMIT ISSUED----'---=--- ----- ------------------- --------------------------- ---------------------------------- DATE--- ----------------------------------------------------i Alterations and/or recommendations---------O. Rj�--_-5I9N�],>/----f5QJ_4-•-_--�------------------------------------------------------------------------------ -•--------------------------------------------------------------------- --/------------------ --------------------------------------------------------------- -----•------------------- ---------------------- ---- -------- ---------------------------------------------------•---------- -----------------------•---- ------------------------------------------------------•---•------------------- -------------------------------------- ---------------------- -------------------- ----------------------------------------- ---- •------ ------ ---- ----------- -------------------------- ------------ ------ --- ------ ---------------------•-------•--••------------------------------------------------- --- -------- -- r A FINAL INSPECTIO y:__ - ____. .- _ - _ ._. Date_. - SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.FEa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,Cafirornia Lodi, California Manteca,California Tracy,California F.P.CC. ` 1 I i I _ i1 1