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FOR OFFICE USE: /.,? - 2 - //, c cam, APPLICATION FOR'-SANITATION PERMIT Permit No.�1�� - ro z �6 ------ ----- - ---- ----- 13r ---- - --`�'•-- -�'? (Complete in Duplicate) Date .Issued -" -�� This Permit Expires 1 Year From Date Issued ,110 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. 549110 . .. JOB ADDRESS eANN4L0ATION:.. _ .- /------. ,�4 ---- --------•---------+---------------------------- -----Owner s Name_- - -- ----- - b. - ---- ----- - - -------------------- -`�------ Z_ -•--------- -------i-------------------- Phone--------- ----------- •------------ „ 7v? _ ,- �-- Contracto)r's Name----= { r------------•i ' ----- -- ------ ------•,e---------------�-------------------- Phone----------------------------------- Installatiofn will serve: Residence ❑ Apartment�House.0ommerctal El TrailerwCourt ❑ Motel ❑ Other ❑ l f -_ � -------------------------- to .�-------------- " Number of living units: umber of bedroO�nfS�f��Number�ofibaths.r_?___ Lot size ��}� .. ' Water Supply:`Public system ommunity system ❑ Private ❑ ''Dept' to Water Table _ f+. Character of soil to a depth of 3 feet:_ Sand C3-••Gravel-0 Sandy Loam ❑ Clay Loam] Clay ❑ Adobe [ �Hardpan ❑ Previous Application Made: [If yes,date----___- No F1 New Construction: Yes [I No [ FHA/VA: Yes E] No �'* TYPE OF�INSTAL-LATION-AND SPECIFICATIONS: 1, k r (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) if 1 -__Distance from foundation_-________ ___.Material------_-_____-.- -------------------------- Sept ic'�a No' o I from nearest well----------------Size--_----.------------------------Liquid depth_...........---------------Capacity----------------------- �� No. of{com artmenfis,._.-.-._____;___ i Disposal Pleb_ Dis..tance from .nearest well-__rte-- _-._Distance from foundation_.,�_47--_____-Distance to nearest I line__ ------ Dispos 'I e I!!r.. Dis.tartclt flrom[tearesf Distance from founclafion_,�t_47--------Distance to neare al F ------------------------ Number of IinF�_ ------/-_-___�._- Length of each line_ -�___ / Width .of trench._ __ _____________________ \ r Type of filter material--��Depth of filter material__ __`.-.Total lerigt31�------=------------------�--- d Seepage Pit: Distance 10 nearest well___.X,�g9__`_DistancA- e-24 fdation__ .��.______.Distance fio nearest lot I�e___;�-w_______❑ Number of pits-_.-A-.-__------_Lining material- .5ize� Diameter___= .-.___Depth n�..-_Awr Cesspool: Distanceif-om; nearest well-----------------Distance from foundation--------------------Lining material----------------------------- `=e; .___.-__-- Size DiametJ--------=-----------------------------Depth------------- -------------------------=-----Liquid Capacity- '' e9als. Privy: Disfance ifrom nearest well..-__r_:_.._____.-_____--_ �_ff ____--_Distance from _nearest building_________________^'�_________-r -.-_ F — ,-- ---------------------------------------------------------- ------ -------------------- ---- ❑ iksDistance}to nearest lot line-------- ----------- ---.-- ------ r - -- - --------------- --(---------._-_.--••-- Remodeling and/or repairing. (describe]------------------1`�� ._.. -------------------------------------•-------T. -=--- ----------------------------------:f ----------------- ---- ----------------------------------------------------------------------------•----- --------------------- ------------------------------------------------------------------------ --------------------------- -------------------=---•------------------,=- ---------------------------------------------------------------• -------------------------- 1 hereby certify that I have prepared thif application and that the work will'be done in accordance with San Joaquin County ordinance$, State laws, and rules and regulations of the San Joa in Local Health District. 41 .-� f ---------- (Signed)--y--------------------- -=---------- -- -� i --4 ----------------- --------- - ------- By' --------------------------------------------------------- W----------- (Plot {Title) =' Plot plan showin size of lot, location of-system in relati o wells, buildings, etc., can be placed on reverse side). � { p � 9I t FOR DEPARTMENT USE ONLj APPLICATION ACCEPTED �BY - �' --------------------------- ----------------- . ------------ - --------------------- s ---- -----� DATE - GS REVIEWEDBY ------------------ ----------------- - � -------- ------ ----------------------------'(-------------- DATE--- :------------------------------------------------------- I ,jV,�BUILDING PERMiT ISSUED--------�--�- � � 7�`1--- ----------I- j "DATE`" f �� Alterations and/or recommendations:._._ �`�, ;W-*. �2'/Y �`;J r f - ---- _----- ----------•------------------ J f• --�F.r-- --------- ----/`-�s-f-------`-C��-----Q------------------------------------------------- ------------------- - - --- ---------------------------- - ----------' ? ._ = � C----= ----- - ---------------------------------------------------------- --------------------- ------------------------------------------------- --------------------- --- ------------------------- ------------------------------ ^ w E 6�' FINAL INSPECTION BY---------f- - -- -- - :--- -- - Date - j Ir —..01-*T- "`"" USAN JOAQUIN L EALTH DISTRICT 1601 P.Ifozelton Ave. 300 Wes Oakk Street t: 124 Syeam'are Street 205 West 9th Street Stockton,California Lotl1,Ca ifornia F manteCa California Tracy,California