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Q� FOROFFICE USE: - y — ` ----------------------- rt„ c - ------------------------- ------------------A__.--- APPLICATION, FOR SANITATION PERMIT Permit No. 22496F- -- 2 496F- ' �Q,(§ tnplete in Duplicate) ' -- --= )hi�i. '&Mif,-Expires 1 Year From Date Issued Date Issued ._r `a6 Application lis thereby made to h Sanopaquin Local Hbalfh District for a permit to construct and install the work herein described. . t :. f This ap9icafion is4rna�e.n.:ZoiYspliance w,lth CSoun.ty Q,ralnance o. 549. JOB ADDRESS AND�LO3ON�._ _ dC�—7 -�Ld._ __/ f�1� C ' °+` ' 11 f Owners3'�Neme ' � ': - -------- Phone4_ �J Address- _ A-�----------- -- -------------------------------------------------------------------------- Contractor's Name ---------------------------------- ------ Phone_ ` =��p�T Installation.willkserve: 4Residgnce '►Apartment House Commercial Wj Trailer Court ❑ Motel Number of livingunits: --.--- Number of bedroa 7` Vis, ---Nu ber of .baths ________ Lot _ - ----------------- Wafer -�---- ----- Water Supply: Publics stem Community system, ' PP Y� ±,� Y y y ❑ Pr�i�ate' ❑ Depth to Water Table __.-__ ft. Character of soil tgadepfhrof3feei andGr�ae1�0 Sandy Loam E] la ay ❑ Adobe Hardpan ❑ Previous Application Made: {if yes,date---- -- --- ------) No ❑ New Construction Yes�t] o ❑ FFiA/VA:=Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank orr-cess ool. ermined if. ublic sewer Is evallahle within 200 feet) ,. +P r. fi Septic Tank: Dist nce from nearest we I�._----_ iD sf lnnce nom f undation_ J -_---. .Material.__--_ A ----------. Li uide th Ca aC� ❑ No. of compartments Size tY �., - ------ �: p I Y .—___ om f jundatio__� ,L �_ Distance to near o f ne__� Disposal Field: Numberoffil in, Distgncfr ach I�ne____2�._ ', -t Width of trench---- um. -len. th .of�efj Type of filter materie6N-------- � .-Depth,of filter riaterial ____ �`,�-._ Total length___-- :.'-� _________________ (3 Seepa e Pit: �DiSta* o nearest well ' .----!::Distance:fr foundation '��5---.Dist nc to nearest lot line__.--- 0 � N :_411 um4�er of piers = - -----Lining materialr__ "r I.e. .. i - --• � _Size: D:ameter.- - - - ------ Depth-- - '�--� Cesspool: Distance from nearest well ----.-----------Distance from foundation._ _ - Li material--. material_ ._.. --------- ------- - -----z ❑ Size: Diameter- -i Deptfr *"" ------------ - --- ---.-Liqui Capacify _ --gals. r Privy: Distance from dear:s} 1-#6 �- --- �+ � _ Distance fr m nearest building_________ ___ ______ ❑ Distance to nearest lot Ian ------ ----------------- ----- --------------------------------------- ---- 0 Q Remodeling and/or re airin (tdesr•be f: I - 1171 - I hereby certify that I have prepared this appfication and that the work will be done in accordance with San Joaquin Count jr ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- - - -- ' - (Own an Contractor) BY:----------------------- ..-- [Title)------ t t (Plot plan, showing size o oto loo do_:o system in r`elaf�on #a ells, E�ii dinc s ke# can bs placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - =--•------------•----------- DATE--------- ' REVIEWEDBY------------------------ ----------------------------------------------------- :---------------------------------------- DATE-------- -------------- ----- BUILDING PERMIT ISSUED------------------------- ------ ------- ATE _ Alteration"� anend"or reco mendation""s="" ---------------I----------- - --------------------- --------------------------------------------------------------•---------------------------------------- ------------------I---------- ------------------- ------------------------------------------------------------- ------------------------------------------------------------------------- ----------------- -------------- FINAL INSPECTION BY:--------- :........... Date----------- 2 - � SAN JOAQUIN LOCAL HEALTH DISTRICT # 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO.