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FOR OFFICE USE: I-t- - _ - - r ____________________ ------------ 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 Health District for a permit to const u t and irista'�'ie wa ren sorbed. { �� plik9tion is made-in..cornplian - h County Ordinance No. 549. , JOB ADDRESS VZ, CA ---- •ll Owner's Name--- -- --------------------------- Pne-_7- 1.4/ .__ Address-------------- J C4 ��--- . ----------------------------------------------------------------- Contractor's Namta._.._ 9F• -- ---------- -- = ---'-`-��---- ------- �� ---- -- -� --- -�---------------- Phone.-- -- � I Installation will serve: Residence [L} partment use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.�__ Number of bedrooms.5--- Number of the ��L ._ot size --_ .-_{ I Water Supply: Public system El Community system ❑ Private Depth to ater Table S- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Fkr Clay Loam ❑ ay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {!f yes,date---------------- -) No%� New Construction: Yes No ❑ FHA/VA; Yes E�<No ❑ ,TYP.E,rOF INSTALLATION,AND_SPECIFICATIONS: (No septic tank:or cesspool permit}ed,if=publi sewer is available within 200 fee .) __. Septic T Distance from nearest well -. _-_0-.__Distance from foun i9p--- �YM i I ! . --___ �/ 1 No. of compartments --------------___Size _ J` Liquid depth__ -------Capacity___ - Disposal Fi Distance from nearest w61_15T. __,__Distance from foundation_ ____ � �.._...Distance to nearest lot ine_��___._. Number of lines__ _- Length of each line �l --�--Width of trench._ �e.---__ . Type of fitter me, rias _Depth of filter material --_- .__CL...Total length----_-_-1-2_ -f_-_--_----_,- Seepage Pit: Distance to nearest well------ _____...__.__Distance from foundation------------------- Distance to nearest lot line______________ ❑ Number of pits--------- -----------Lining material-------------- -- --..Size: Diameter---------------- -----Depth----- ------------------------- Cesspool: Distance from nearest well------------------- from foundation__________________Lining'material__.___---_------.------------------- ❑ Size: Diameter T-'._.. Death -------------- --- - ---------------Liquid Capacity----------------------------gals. 4 Privy: # Distance from nearest; ,we --------------------------------------------- _ _ I__Distance from nearest building-----._------------------------------------ El _------___________--_ -❑ Distance to nearest lot'line_______-.___.____�________________ ► Remodeling and/or repairing (describe)- - -----------+-- ------�---------- ".--------------------------------•-------------------------------------------------------- ------------------------------ ----------------- !.-I--------------------------------------•'---------- ------------------ --------------- --------------------- ------------------------------------------------------------------------€----------- 1 -- t 1 I hereby certify the have prepared +his application and that the work will'be done in accordance with San Joaquin.County ordinances, State laws, aAeules and-regulations of the San Joaquin Local Health District. Si ned eLlay C� '1�i��t - --( 9 �..)----ySE1 _ric--TANKC SEF2VtC�- - ----- ----- -fwe4s, --- -- -- ------m it/or Contractor) .. - 2915E MinerAva�.- { - �� - - ,o^* -, ,.�—B :--- -------' a.---3sai - --------------------- --------------- -------- ----- (Pio+plan, showing size of fot,,.locationof,sys+em,i elation,to din s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY rr APPLICATION ACCEPTED BY_.. i- - '.----------------------------- ---------------------------------------- DATE------ -If_- .7_ Q.S--------- REVIEWEDBY------------------------- ---------- -------------- -------------------------------------------------------------------------- DATE - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------- ---------------- DATE Alterations and/or recommendations----------------------- ------------------------------ , ---------------------------- ----------------------------------------------------------------------------••------- -------- -------------------- r 9 ---------------- - --------- - ------- - --------------- ------ ----- - FINAL INSPECT! Date-------------- 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.C q.