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t-UK U,t„FICE UI E: - ----------- ---- ----- ----- -------- ------------------- ------------ ----------------------------- '------------------------------- 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 con ct and install the work herein de ibed. This a_pplication,.is.made in compliance with County rdin rice No. 549.. rtJ ,Zcf7�f .20 8 ADDRESS h —12_ _ D LOCA-TION__ Owner's Name-',11437— O - s1cr e _ , hone_ g ' - rAddress_.P.© _ --------- --- - -.---•---- l:c__. Contractors Name_________________ _ Installation will serve: Residence [Apartment Hou e',0 Commercial ❑ Trailer Court Motel El Other Number of living units: __ ----- Number of bedrooms�__ Number of baths _ _ ____ Lot size,_ ❑ s- 90* ----- ------ Water Supply: Public system ❑ Communit system Y y ❑ Pri'va�te ;?' Depth to Water Table+ ft h- F Character of soil to a depth of 3 fee t• Sand 0 Gravel ❑ Sandy Loam K Clay Loam ❑ Clay [] Adobe ❑ Hardpan Previous Application Mad {!f yes,date____.... ---- I No " New Construction: Yes ❑ Nbt FHA/VA: Yes ❑ No ❑-_ i -TYPE..OFTINSTAL-LATION-AND'•SPECIFICATIONS: {No septic tank or cesspool permitted if public si�keD�is available within 200 feet.} Septic Tank Distance from nearest weir_ tion__ r �..__ '----_.Material _ �� ante from founda •L+ Li ui • ( t #;ism � -- •-_ q d de th-----•-.�.-- --'- Qr No. of tom arfiments- -- t-- ----'-' ize � p --'- •� CapaatY--�o�'----- "�.J Disposal Field- Distance from nearest wells - d lilD. _ Dist �f i _. ._. D stance .from foundation_ ante to,�nearest lot linea' �f 4? ;<.. [� Number of lines apt f each line__ _ -t - Wi&6-of trench. __ s Type o filter material- :_ h o{ filter material_ " -- eng h o 1 Total I ngth �:;. Er Number r 3:' g - Size 'p `et '_,. e to nearest well.__ - - -___. Di fiance - o nearest lot line Seepage Pit; Drstanc of 'its... __ er ro foundation,, Q-. AM - p -.----__ -Linin materialstance t Deptn i% {---'-------- Cesspool: Distance from nearest well -_----- __ __ Ir Distance from foundation f` ❑ Size: Diameter. ._ '•' ---.-- -..Lining material _. ------.-_ .---- __---. ll 1 .-- --- -' --- --- Depth----------------------------- --- Liquid Capacity els. P.rivy.:- �.. Distance=from nea'�est well__ --�� ":�*.:=�" ;f "", W _-° g- v . --- --- ---- _•_. Distanc'te from nearest building ❑ '� i % Di�thhce to nearesf-lotjine ----------------------------- Remodeling and/or repairing ! } . . : ::::::::::::::::::==::::::::::::_:::::: ::::::: ::_:::::::::_�----------------------- ----° - ::::: _ =:::: :----__�k:::: :: :: -- - -- ---------------------------. .----- -------------------------- ------------ ------------ 4. p_-:------------------------------------- - --------- It ertif that Ilheve. eared this application and that the work will be-don--------------------------------------- --------------- --------------- ordinance S to la an r" s an re ulati s of the San Joaquin.Local Health Dione n accordance with San Joaquin County stric(Signed)------ r - -- --- --' , . ._ � . - ---- -'--- •- --- -'- }��.-. --- er and/or Contractor F ' (Title) $y:---- ------------------ wn Plot plan, showin y — -- --._ .-._ `. p showing'size of I t cation of s stem in relation to wells, buildings, etc., can,be placed onkreverse side). w� int a FOR DEPARTMENT USE ONLY D APPLICATION ACCEPTED f3Y-t-----I �1•. '------- ----------- --------------------- ---------------------- DATE'1�`sl' Z/ , �� -------------------------- BUILDING ' ' REVIEWED BY DATE----------------------------------- - _ ---_-----------------------.----------------------------- ----- BUILDfNG PERMfT ISSUED_ . ;--------------------------------------------------------- ---'------'--- - ---------'-'-------------- - - - ------ --------- - ----------------- - --' - - DATE--------------------------- --- - - -------------------- A terati -and/or, recommendations_______ _______ -' ---' - _ - E r ..---------------------- --------------- -4,..,_-�::_,_:-.._ - ------- ------------------------------------------------ --------------------------------------------------------- FINAL INSPECTION - 2/-6 - Date--- SAN ate--SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave, 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California � Manteca,California 205 West 91h Street E.H.92M 1-67 Vanguard Press Tracy,California r