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FOR OFFICE USE: -------- --------------------------- ----------------- - Permit No. _-_j--- -----------_----------. APPLICATION FOR SANITATION PERMIT ------------------------ (Complete in Duplicate) -- ,Z 2' Date Issued ....... ..... .�� ----------- This Permit Expires 1 Ycfar Fret Date Issued ! Application is hereby made to the San Joaquin Local Health District'for a permit to construct and install the work her,,in described. This application•is made in with County Ordinance No. 549. r��'LS��_(SD JO ADDRESS AND LOCATION S /�� _. -..� '. i'3 i 1—SM4'V �: 1�_j.- 11p .- Owner's Name _. _'-•-- D._ .i�l�_!-1__j�4�4� �� j.1-I��----- ---------------- =-------- Phone_.O_�'5_5.J 3- t + Address .� ot - Phone -------------------------- Contractor's Name-------- - - ----i-----------••-------------- ence Commerc�� rut 'gall O4er ❑ +Ins#allation will serve: Resid ❑ mr ❑ f Number of living units: urlberiof bedrooms -_._____ Number of b ths -__.____ Lot size _---__3_4<�1ea:s---------------- Water ---------------Water Supply: Public system ❑ ommur ifsystem ❑ Private Depth to Water Table _ /A f I Character of soil to a depth of 3 feet: L11 i Gravel ❑,til Sandy Loam ❑ Cljkoam ❑ Clay Adobe X Hardpan ❑j Previous Application Made: (if yes clafel__. ---.) Noy, New Con struction?'Yes No ❑ FIiA/VA: Yes ❑ No ,� X �, ► TYPE,OF INSTALLATION AND SPECIFICATJ!ONS: V septic tank or cessspoo-1 per i��_if_piilsli wer s availab a-with 200-feet.)- (No Septic Tank: Distance from Lar8s wel[-----------------Distance from foundation__�i�__ -----------_Ma epi I_ __ S. _C�a ? �� 1Capacity � ! + Na. of comparlmenrfs^ ...� Siz` .F3G -Li ui de.tith _I �`�r q -p - � �� I Disposal Field: Distance from ears ell ----------------.Dis+thnce from foundation---�"r •..._. -_DisMde �o nearest lot Ione___._-____-__ p ► Number of line_ __�P __._--- -_Length of eal h line....._�_ _�_.-._------Width�of tr rich.____.. -r1.----_'- ---- � - t ---- �---. ;- - - g � 1 . t t 1 T e of filter Cer a!____ ��1<.-_Depth of filt r material--------�_� -__-_Total length_------ _ ao__''�--._ Seepage Pit: Distance to nearest vielll._.�_____ _ Qistan�e tolnearest lot line_.-._.;t fir_ I _Distance fro foundation__:..._____._- t ❑ Number of pit _--- -It-Jell -1--Lining mater.�al----------_n..._!Size: Diameter._-___-- ---.�; -.- --Depth--------------- f`_:_.-- �� ly,, Cesspool: Distance frorrrinea}e -----------------Distance fro m'f undation. ---- ----.-.Lining mate isl------_----------------------- _.._.__. ❑ Size: Diameter_ .I I---- ---------.Del3"fh--- -- Liquid^ Capacity -- ----------------- 'gals. to 9 Privy:* Di ancewfrommearet:welf---------' :_�� _�. _Distance rom PCarest b ildm _.___.__ _____________� ...` . ❑ - - f . • n} lot Iin�.... � _. �� --------- is rice to ne rest T + Remodeling a or repatr�ng (describe;)]- �- -- --------- -------------------- -....---------- ---'- :._ . 4 1 11 -------------------------- - ---------- ------�-'----I-------------------------- oqff , r. ___i_ __________________________________..______ _----_-----------_----__.)IIA?-._ 9 t i i t l I hereby cTetify that I have prepared this.application and that the work;will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the Sa&.Joagwn%Local Health District. I t ! t 1 4� 3 l ' : + £ t - (Signed) -�'�_. ----- � ----- „•'-------------+- - - - ------_ :--------- -- - - -- -�- i(O per and/or ont bac or , , � g ��- =1 .01 --- )Title) H TM (Plot plan, showing size of lot, location W ssystt in r�l�tion.o wells, Liuildings, etc. can be-placed on ne se side). I FOR DEPARTMENT U E ONLY _ I I ... .,. APPLICATION ACCEPTED BY ---- ------ = --- - ------ DATE "1 BUILDING PERMIT ISSUED f ------------ ----------------------------- ------ DATE----. I I_^� ---------- REVIEWED BY-------------------------- ------ ,j --• ------ , 1 I # --------------- -------- DATE I ------ ------ I Alterations and/or recommendations:---------- ----- - ------------------ ---- --------- --------------------------------------------------------------------------- ------------------------------ - --------------------------------------------------------------------------- -----------------------t -------- -------------------•--------------------- ------------- ----------------------------------- ------------------ ---------------- ---------------------------------------------------- ----------------------------- ---------- --------------------------------------------- ---------f---- f FINAL INSPECTION BY:. � G� Date - ----- � ---- --------- ------------------ } { SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street h Stockton,California Lodi,California v, Manteca,California Tracy,California Ir.P.Cq- 4