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FOR QFFIU4JSE; wf --------------- ------------------------- -- - ----------------------------- APPLICATION FOR SANITATION' PERMIT Permit No. ---------------------- ---- -- -- ----------------------- ---------- ----------- (Complete in Duplicate) Date Issued --- -- ------ --- ------------------------- 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. P c 1,j JOB ADDRESS AND LOCATION CRN--- ----loiLa------------- 7 - 1V API-�__- Owner's Name-------------------R'&_14AA_b-------------VAEIV-13-a R.C_ ----------------------------_ Phone------------------------------------ Address------------------ JF—----------Illm-N-A . Contractor's Name"',-----Qwk a___P_'11---------------------------------------------------- ------------------------------------------------------- Phone__-----------................. Installation will serve: PesidefIce tl'--Apartment House [] Commercial E] Trailer Court E] Motel [3 Other E] Number of living unifs.1---/__ Number of bedrooms 3-- Number of baths Lot size --------1-:5- :;Z�i 0-C-2-------- ------ Water Supply: Public system E] Community system E] Private W"'Depth' tc; Wat;_rTAbI;2_S-_ft. Character of soil to a depth of 3 feet: Sand VGravel E] Sanjy,Loam E] Clay Loam E] day [:] Adobe E] Hardpan 0 Previous Application Made: (if yes,date________________--) No 2�<New Construction. Yes 4��No tl FHA/VA: Yes No ❑ I v _TYPE OF INSTALLATION-AND-SPECIFICATIONS:..,--_ _ .,, y � _ _,. �. _rti (No NSTALLATION-AND-SPECIFICATIONS:.._--- (No septic tank or cesspool permitted if public sewer is available within120646-0.) Septic I . .1 peT nk: Distance from nearest well----r5W---Disfance from founda'fion-------119------Material E�----------- ---- - ----- No. of compartments---------2------------Sie! L_iq_`u_id�det pD,fh Capacity__/7__C_?.p--- Disposal Field: Distance from nearest well._.,A5_._0_..___.Distante from foundaflon------10 r._.Distance to nearest lot ------- Number,9f lines--------------7-- ----------------LePq , ;f each ________Width of french. 't-36 Type of filter Depth of filter material length_-_-_ �_ _._`_ !� ' _____ -----------Distance to neparest lot line---- -_T�..- �`�� ' Seepage ength----- ------ Seepage Pit: Distance to nearest well_____________ _____/--Distance from foundation____---------------Distance to nearest lot line---- 171 Number of pi;SN_------------------Lining" material-----------------------Size::Diameter-----------X--- ----Dept h------------------------------- Cesspool: Distance from nearest'' well------ ----- ---Distance from found1t�,n____'i---------A ninlig materia�-------------------------------------- 40 El Size: Diameter-----=- ----------Depf h t-_�;r kl ----------- -------------------------- .- ------..Uquid Capacity---------------------------gals. Privy: Distance from nearest —.-:-Di-Distance from nearest ------------------- ------------------------------------------------ 7 ---------- ❑ Distance to nearest lot line--------------------------------- -------------- ------------- jk Remodeling and/or repairing (describe]:_.____._____----------------------------F�---------------- ------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------I------ -------1---------------------------------- ------------------------------i------------------ -- --------------------------------------------------------------------- ----------------- ------------------ ------------------------- ---------------------------------------------------------:---------------- ------------------------------------------1. -01 1 -------------------------------- ---- --- -- ---- I hereby certify that I have prepared +his-ap�licafior! and fhat-the work will be done in accordance with San Joaquin ' .4 ii. � . ordinances, State laws, d rules/and ereul ions of fh San 0 qu'fn Local Health District.'—4 (Signed)------- 4- . ................... . ..... .. ..... ....... ------ ----- -- ---- -- ---------------- ----------------------------------------- Pwjer and/or Contractor) Y:-------------------------------------------------- ---------- -----------------------------T Title---------------------------------------- - - - - --- --------- Y= [T (Plot plan, showingwelts, buildings, etc., can be placed on reverse side). size of lot, location of system in relation to we FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- j?4-0--------------------------------------------------------- ------ DATE------4:2---- 415 -------------r-- REVIEWED BY------------------------- -------------------------------------------------------------------------------------------------- DATE---------------- ------------------ BUILDING PERMIT- ----------------------- ` ` ' _—. - - - -- DATE.- ------- ----- - Alterations aid/or recommendations:---- 1 & .R ....* CHANG26d7Cr ---- - -- - ----------------------------------------- _ - --------------------------------- --------------------------------------------- ----------------- ----- ----------- --------------------------- ----------------------------------------- µ %i r # rl e1Lig ------------------------------I------- ---------- ---------------- ---------------------------- -------------------------------------------- ---------------------------- .A--------------------------- ----------------------------- ...... ---------------------------------------------------------------------------- ------------------------------- Date------------ 2-(- -- ------------------------ ------- ---------------------------- -------------------------------------- - ----- --- ---- -------------------------------------------------------------------------- ------ --------------------- 'T I m FINAL INSPECT ut SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California L