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FOR OFFICE USE: ------ ------------ ------------ Permit No. ..../._ l�` " APPLICATION FOR SANITATION PERMIT -------------------- - (Complete in Duplicate) Date Issued . a._a?Jr.,�� _----------- --_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instals the work herein described. This application is made in compliance with County Ordinance No. 549. FSS - < < 1 �lll t L 1 '''�_- --- Q Al JOB ADDRESS AND LOCATION��"��rb---- - - - ---_ - -- -`- Owner's Name-----------IKF]Vi�_� -------- '--�-------MAT)--�V- ` '= Phone-- Address__-______. __ � __..__.. Its- 5 �-----A�a�--------= V.2>_j- I----------------- ---------------------------•----------- CContractor s Name------------��!_�_��---�----------------------------------- -------- ------ ------------------------------------------------- I ontractor's ----••--------- Mot Installation will serve: Residence �partment House E] Commercial E] Trai�er Court ❑��4 -.6 ❑ Other ❑ Number of living units: l... Number of bedrooms Number,of baths .______ Lot size __. rd► - 1 �_S_ft. Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table Character of soil +o'a,depth.of 3,feet:—Sand ❑ Gravel []Sandy Loam ❑ 'y Loam ❑ Clay ❑ dobe ❑ Hardpan 01 --- Character No Previous Application Made: (If yes,date-"------ ---------1 No New Construction: Yes �No E] FHA/VA: Yes ❑ 7 j TYPE-OF-INSTALLATION AND._SPEC]F1CATIONS: _ -- . .� :�=� -�-_ � - -" (NSeptic tank or cesspool permitted if public sewer is available within 20n,feet.).,,_.,.�.,..,..�..�».....- � o sep p Septic Ta Distance from nearest welk--------------t Distance from foundation------------________Material.----------------.____.---------.._"-_----____. "Size_ ------"; -Li uid de th-------------".--- Capacity 1Srf�-• No. of compartments------------- ----- --- -•------�'-- � - - _q � P. - --� p Y•--------- --�--- now "` ^` _--_----Distance to nearest lot hne`_� Disposal Feld: Distance from nearest well__ . _Distance from foundationf� L` III Number of lines------------1_._.____---------._Length of each line__�0--"-----�------.Width of trench.----.-----,7-------------------- Type of filter material._��.Q Ck_%Depth of filter material-___.� ""---."".Total length____.-_-__, - -_______----""__-- 1 :�11� •� �� S.izeDia��r Distan e toDepths .l1 � Seepage it: Distance to nearest well-___7_ --" Distance from foundation___.._ Dumber of pits.-_------} Linin mateal__ _ . 4 g ----------- - ..• -e.s.r•+ { x Cesspool: Distance from nearest well_--___._. -Distarlce from kfaundation: .-_1"-"_--------xining material__`-----._ ------------- Size: Diameter------ ------------- --------- r. De.ph -.--------------- -------------# ------Liquid Capacity---------------------------gals. t ------------- -------------------------- Privy: Distance from nearest well_:` ______________________ _ _Distance from nearest building ❑ Distance to nearest lot-line-'�--�.---------- =_ _,, ---------------------------------------------------------- Remodeling and/or repairing (descr" i e� ):-__:=.s------- --------------- ----------------------------- it ---------------To--------- �?.1�----- 1 � --- ------- ------0--------------------------------- ' ` � ------ ' ha I h -------------------------------- ----------------------------/------------------------------------------------------------------------------- ------------------------ I hereby certi . ve prep d this applica 'on and t i t the work will be done in acc=rdance with San Joaquin County ordinances, St ands ,y an re lations o he San oaquin Local Health District. I (Owner and/or Contractor) (Signed _ R _. "'� — �-------------------------------------------- (Plot - 1 - - -------- -- Title)............... ---- ......... - -- _ . { �- ( A�---------o 'fir ABY •-•----------------••_-------.--- ----------- --- - -------- - ------ -- (Plot plan, showing size of lot, locati f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- x. .�- -- -- DATiE ' lO ZZ— ----- -------------"-.--- /- REVIEWEDBY----------------------------------- ------ ------ ------------- ------- - --- ------------------------------ •-__ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE.------------------------------------------------------------- Alterations and/or recommendations------- ------- -------- ----------------------------------------------------------------------- ------------------ ------------------------------ ------------------------------------------------------------------------------------- --------------'-'---- i ---- = ',- 1*.h day -------------------------------------------- ---------- ------------------ -- ------- ---------------------- - -------------- FINAL INSPECT - Date---- 2_17 ------- - -------------------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F:P.0 O.