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FOR OFFICE USE: ------------------------------------- - ------------ ----------------- ----------.___-_--_------.__Ji_---. APPLICATION FOR SANITATION PERMIT Permit No. Add a6: ....................... -------------------- -- ------------------- ----- ---- (Complete in Duplicate) ------------------- ------------------------ - This Permit Expfres"i Year From Date Issued Date Issued bv�-44�1 Application is hereby madd 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 Ordinanc' No. 549. -rc /W1—)9- JOB ADDRESS AND LOCATIONVE-T Owner's Name-, Wi -1,AX-F ..... ------WqLTHA_,�J-------5j_auc -- ---- ----------- -- ------JE:--Rl3E.F----------/,A.K.F-- ------------A!----------- ---------------------- Phone----------------- ----------------- Address--------------RIFIF------L�---3---------0ox--------- ----------------------- ------------- - -----------ff. .01 1 ContractorsName---- ---------------------------------------11 .------------------------------- ---- ---------------------------------------------- -------- Phone_ - Installation will serve. Residen.ce ❑ Apartment House El Commercial E] Trailer-eawRa-,Motel El Other E] Number of living uni S. ---- Number of bedrooms liNumber of baths ----1--- Lot size Water Supply: Public systg I m El Community systemP`I�r ,te El Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [ravel ❑Sandy Loam El Clay Loam Ej Clay E] Adobe C] Hardpan [I Previous Application Made: (If yes,date------------- ---- -) No New Construction: Yes P--lqo Ej FHA/VA. Yes E] No e- TYPE OF INSTALLATION AND SPECIFICATIONS: -(No septic tank or cesspool permitted-if public sewer is! available wifhin:20 0-feeh)- Septic T nk: Distance from nearest weft--..a 0----Distaw-e fiom f9und flon-_10........ Material___ No. of omparfments--2=------- -----...Size _7k-�3---W.!!Liquid depfn__�V2_ Capacify------194.0, Disposal Meld: Distance from nearest well-5-0------Distance from foundaTio_"n_1__,9__-----.Distance* to nearest lot line-5- --------------- Number of lines.---- ----I------- Len tai of each line___ -----"".Width of french--- f* h! /1 PC ----------- iiter material._ OC Dept Type of 11,6f filter material'""- -------------Total length---------------------1 00----------- Seepage Pit: Disfancejo nearest well-------------_._.----c-0iistaribe from foundation....................Distance to nearest lot line--.___-------._ Number of pits----------------------Lining maferial----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest w❑ ell---------------46isfan I e from foundation--------------------Lining material-- ------------------- 11 1 1 ------------- Size: diameter----- -------rf------4K-.,--------Depth.-, '_'_,._Uquid Capacity----------------------------gals. ------------------------------- Privy: Distance I I from nearest we]. .--.--..____.....Distance from nearest building.------------- -------------------------- I-101 Distance to nearest lot line------Z---------- --------'IM- ---------------------------------------- ---------------- Remodeling and/of repairing (describe):---------- ----------7 0 1_SF__ -------------------------- -------------gyp` -----iv--------I---- ----------- --------------------- -------------------------- ---------------------------------------------- --------11- ------------------61a --- -- --I------------------------- ----------------------------- ------ ----------------------- --------__-------------- -------------------------------- __ - _11----------------------------------------- ----------------------------------------------- ----------------------------------------------------------11-------------- ------------------------------------------r--------------------------------- I hereby certify that I hIlve prepared this application and`that the work will be done in accordance with San Joaquin County ordinances, State laws, and Itules and regulations of the San A' quin Local Health District. Joaquin ------------- (Signed)---4�. ------- --- -------- -------------------- ---------:------------------------------------------------------------- - (Owner and/or Contractor) ---------- gY= = Y--- ---------------------------------------------- —-----I------ ------------------------------ (Plot plan, showing size of loifi' location of system in relation to wells, buildings,I} wl etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-._.--...-rt - ----------------------�1_---------------------------------------- DATE-------BY- It P). ---6--------------------- ------------------------------------------ DATE ------------------------------ BUILDING PERMIT ISSUED--'----------/_ZA 7n 6.a-----------------------------1�-------------------------------------- DATE Alterations and/or recomrre�ations-----------VE.NT--5. 30 ---------- W-5---------- ------------------------- --------------�:77�t4--------- -------------------------------------- ---- ----------------------------- ------------------- ------- -- ------ ------------------------------------------------ ---- -------------------------------------- ----------- If! 4 ----- ---------- ------ ---------------T_.R_ ------------------------ ------------------------- ----------------- -- --- --- -- -- --------- -------------------------- - ----------------------------------------------- ------ ---------- --------- ---------------------------- ---------------- --- -- -- ----- - ---- -------------- - ----- --- ------ - ----------------------- ---------------------------- --------------------------------------- FINAL INsPE-cTrom B Date.. -----------/ 4r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Streetod 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.C L3,