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FOR OFFICE USE: ? APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------- - ------------------ (Complete in Duplicate) _____________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein•described. This application is made in compliance with County Ordinance No. 549. . JOB ADDRESS AND/LOCATION --- - ------�-- X -; ------------------ J f.t�Ij .[ ------------------------ * -- Owner's Name__ _Q IT " _1 E ".,�` � E lel Phone -----------=------------------- .. .,.....-�, t. .... .'...�. �,,. -.-...r..... ..,� Address-----------1/_�a- Q------ _R_t 111 �4 ---------------- --- ----- --r--------------------------------- --------=-------------' Contractors Name, �- L!.--�P---------------•-------- - Phone Installation w//server Residence )J [ "Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑r Other ❑ Number of living units: _-L Number of bedrooms _3_ Number-of baths 4-_ Lot size ____---_f - 13;-- _________________ Water Supply: Publics stem Community system Private ,�,/De +h to Wafer Table _ ! � PP Y Y ❑ Y Y ❑ L� p -- ft r Character of soil to a:depth of Ifeet:�Sand Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe E] Hardpan C] ' r� i _ # Previous Application Made:�(if yes,date til No New Construction: Yes 2-1�10 ElFHA/VA: Yes ©"INo E]71- TYPE ONo Ise t stank`00 cessAND ool-permlltted ifOublic sewer-Is°av fable-wi+hinr2 t r� ti • — ""��- -( P P P � p r . ,. 00=feet:} �`„_„ Septic T •k_ Di's�ance from well-_ 5 ---'Distance from foundation --- M_'r at_e.ia! /JOCr IS..�_TE�-p-- - .. �O� CapacitY__- �Naof compartments-- �_ - .Size__V_XJpX �_Liq,id depth__ �. Disposal Field: Distance from nearest well.__50 -Distance from foundation _- - /� p �Q_-_ Distance 't�earest lot lm��____ ___------- Number ______ [L}�� Number,of line s_-_-___2_.r-. _"_Length of each line__26"'t_,_7.V_._.Width ofltrench_-_3.6 l-:_ 'j► llmwType of filter'. aterial__ a: -Depth of filter material__--,: �-_------"Total length--- _______ Seepage Pit: DMance to nearest wall_'___-----------------Distance from foundation---------------------Distance to nearest €ot line-------------- -• [] Number of pits --------------Lining material--- --------------Size:-Diameter -- - Depth-------------------- ---_ Cesspool: Distance from nearest well �__- f_-Distance from foundation ---------- Lining material_ _ Si e.: Diameter------ ('")---------De th_----------- - ------------=3----------Li Liquid Capacity ---- gals. El � 1 P G p ; Y --- - - -: I ❑ Privy: Distance from nearest well._Distance to nearest lot jive._-____------------:•------------------------^Distance from nearest building_______.__________________---__" - - well.--.-.---------l_____-__- ___- -----" .-_ j ----------'---------------------------------------- Remodeling ------ - -------------------Remodeling and/or repairing. (describe): - " : ------ .,---- -- --------------- ------------- - ---•---- R ------------------------------------•----------------------------------------------------------------- -------------------------------.------------------ ---------------- - ------------------------------------ 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. . I. (Signed)------` •---� - ._-_______ ---------- __---------:--(Owner an.d/or Contractor) BY: ------------ - ---------- --------------------------------------- -- ---------- (Title)------------------ --- - (Plot plan;shawing size�of-lot, location of sy+em in relation to Wels;buildings,etc.,can�be placed on reverse sidel. . FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTEDl BY7_,_R=10- --------------------------------------------------------------- DATE------II-_17__.65 ----------- REVIEWEDBY------------ - _._ DATE----------------------------------------------------------- BUILDING --- ------BUILDING PERMIT ISSUED-- --------------------------------------------- -----------------------------------_------------ DATE---------------------------------I------------------------ eraions and/or recommendations:-:----- A------- =__ - = `--- ------- -- ------ a-------- - Alt _ _. ------------ - ----- -- ------- ------------------ ------------- -------------------------------------- ._----_----------------------------`-------•--- --------------------------- ----------------------------------------------------------------------------s------------------------------------ ----------------------- ------ ----------- ------------ -------------------------- ------- --- ------------------ ------- ---------------------------------------------=------------------------------------------- f -------- --- ------ ------ -------- -------------- ---- . - - ------------------------ -------------- ------- ----------- -------------------------------------------------------- j FINAL INSPECT N BY . . Date / --- -� 5�� SAN JOAQUIN'LOCAi?HEALTH DISTRICT �h'r - 1601 E.Haxelton Ave.. _ -300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi,California Manteca,California Tracy,California F"F;Go.