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FOR OFFIq USE: ' �7 2 ---�----------------- Permit No. .• 3 ....... d u --- ------ APPLICATION FOR SANITATION PERMIT �►. f (f (Complete in Duplicate) Date Issued ---- ---------- - ` - , This Permit Expires 1 Year From Date Issued ----------------- Applicafiion is hereby made to the San J quin Local Health District for a permit to construct and install the work here in'descrbed. f This application is made in compli with County Ordinance No. 549. � � __ __..__ �_______ _ __------- JOB __ __ t..____._.__ __-____._____.__. --------------------------- _.-.___.___.__..___.______.___.___________. JOB ADDRESS AND. OC , 100 Ph d.v.�� '�i� - ----- one.-----------•-------••--- . ., Owner s Name--------- ---• ---- ----------- _ o+ " - ------- ----• -------------------•--•----•---- Lr' Address. - �/ ._! !�/ � /" ---------------------•--------- g --- Phone---------------------------------- Contractor's Name------'----= �'V ----- - Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence g]--Apartment House ❑ ❑ rye' /_, 'size ---7,/ X1 --•--------- = Nai+ilberof living.0 -- Number of bedrooms _ Number of baths _.__.__ of l . Water Supply: Public system f� El ❑ De e 7j?- Community system Depth to � Water Tab Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ "Clay ❑ Adobe g?-TTardpan ❑ Previous Application Made: (if yes date---,___.__..___�1.�No g�,- New Construction:' Yes ©!'No ❑, FHA/VA: Yes p-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- o tic tanor cesmitted if public sewer is available within 200 f {Nse k spool per ,�- P .. `_..__.Mahal__ Septic Tank: Distance,from nearest we}�_________________Distance from foundation--- , , / Ca aci No. of compartments-- ---------- SIZe�V..__, Liquid depth P t �f $ 1-1,1^4 / i Distance to nearest lot line. ___..___... Disposal Field: Distancel.from nearest welL___'�-...-.Distance from foundatio - j1q'r hof trench_ -_____. l� Len th of each line___.__ -�� x--- .-. . -------------- Length lines_______!___ =--- 9 Type of filter material � Depth of filter material ------ D' --•--Total length____ =_.____�'- _-9-0` -f �..... �.. Ze--;---- ', Ei I Depth- Seep Pit: Distance to nearest ell-____'r'_.___-_-.D,+stance f m fo ndation___ ._ .. ` Dist me to nearest lot !i e-` ----_-_---- Number of pits____- Linin material 'Size: Diameter_t _ __ Depth- g I nce from foundation-_._--'-�_----Lining.'material---------------------------- Cesspool: Distance from nearest well_________________DistaSize: Diameter-------------------- ----------------= Depik---------------------- -------- --- � �._l Liquid"Capacity gals. ❑ , -�, Privy: Distance from nea'est well- --.___--_%-_ _____.-- .- -----------Distance from nearest building_____._---------------------------•----- T, 'Distance to nearest lot line ~--------------------------------------------------------------- ------------------------ ❑ --•------ • i ------------- rs- _ --------------------------------------- Remodeling and/or repairing:(describe):--------- _____________ ______________ -----•----------------4,, --• ------------- ------------ — ; -. • ------------------------------------ -------------------------------------------------------•--- -------- ---- ------------------ ------------ ----- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,'and rules and regulations of the San Joaquin Local Health District. 4 -1-1-1-1- ----1-1-1-1----1-1-1 -1-------- - Contractor] (Signed) ------- By:----------------------------------- Y: -------------- _ - --- --1-1 -1-1-•-----------•------ -- tPlot plan, showing size of.lot, location of sys+e relation to wells, buildings, etc., can be placed'+on reverse side}. , 2 — - - 'ONLY— By ..,._---� -- 'F4R`•DEPARTM�NT'USE-ONLY r DATE ; APPLICATION ACCEPTED BY__ = DATE. --------------- REVIEWED BY---------------------------------- ----- ---- ---------------------- - �------ ----- ------• DATE--------:..-•-------- BUILDINGPERMIT ISSUED---------------- ---------------------------------------------------------- Al ration and/or recor�tmen ationfr--------------- s ] r- "-_ �- -- 1r -- - �_._ .. -1-1-1-1--- •- -�-=-- - --.-`�7--:.- �. �'-------• -1��-•-----------•----------------- ----------------- ------------ ,. ---------- --- ----- - -: ..z �.M ------- - - --- - i ----------------------- ---- - Date-----------7-------- ----- ---------------- FINAL INSPECTION RBY------ SAN JOAQUIN LOCAL HEALTH DISTRICT -_ 130 South American Street 3oo West Oak Street "� ( 124 SycamorS�reet 265 West 4th Street Stockton,California Lodir California Manteca,California ° Tracy,California i E6-9 REVI9 ED 9.59 F.P.00.7M 6.60 - f4