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7* -_'�'�FbR OeFfCE USE: =7 �+ ----------------- " APPLICATION FOR SANITATION PERMIT Permit No. .. _.�- - -------------------------------------------------- -------------- ----- -------- --------------------------- (Complete tn:Duohcate) Date issued ____-.---------------------------------------._..__ This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .. - 13 ----------46-NE....--- - _i E JOB ADDRESS,AND LOCATION----------- -7---.- .ti r r -- +� fy_ -------�'------ ----- ---------------------- f - ^ . r ....._Phone"""""' Owner s Name ------------------------- Address.------- = ---------- --- ---- ----------------- --------------------- — � ._--- Phone----••-•-----------------Contractor s Name--------- - ------C)ILV_tE_ ------ t Installation will serve: Residence � Apartment blouse E] Commercial ❑ Trailer Court [IMotel ❑ Other ❑ r` ffi ---------------------- • Number of living units: ___I___ Number of bedrooms 2n. Number of baths __ ...__ Lot size _ ��Q-�--- 00 l------- Water Supply: Public system �Co.mmunity system ❑ Private ❑ Depth to WaferZalble __..___ t. Character of soil to a depth of 3 feet l Sanci�Pn-'-Gravel ❑ Sandy Loam ❑ Clay Loam.....-Il Clay ❑ Adobe ❑ Hardpan ❑ 4 Previous Application Made: (If yes,dafel - - No New Construction: Yes �No ❑ FHA/VA: Yes No ❑ r TYPE OF INSTALLATION A140 SPECIFICATIONS: ..(No-septic-tank_or--cesspool-permitted_if_-public.sewer.is_available.wifhin_200_feet.)i - ;: Septic Tank: Dista ce from nearest well----------------Distance from foundation_______________ __pMaterial-...--_-.__-___-___--------._.---___.__---_... -a•r' rki No, ..00f, compartments------ ----------------- Size-----------------:------- -----Liquid depth.'-------- ---------------Capacity---------------------- {�, ' t-. .... Disposal Field: Distance,fram nearest well..l ..V1I__Dlstance from foundation____ __-_r_.Distance to nearest lot line r/a Number of lines-----_---_-/--------------------Length of each line------30--- ------#--..Width of trench.-----��2__ ----------------- �D�~ -- --- -. - �3- Type ofjfilfe�mafe`rial__=_ - _Depth of filter material_"_._/7-_�_------Total-length______._____.._ ...f-------.-- f ? ..� i Seepage Pit: Distance to nearest well______----------------Distance from foundation-------------------- Distance to nearest lot line----------------- t �] Number of pits------ ---------------Lining material------ --- -----------.Size: Diameter Depth Cesspool: Distance from:nearest well_________ Distance from foundation__z _._____-..Lining material---._-__--.._______.__.___ ------ . + Size: Diameter------------------------ -----Depth----------------------------------- ----------------Liquid Capacity----------------------------gals. -_-Distance from nearest buildini ✓b Privy: Distance from nearest well---------- ------- ------------------------------ g---------- --------- ---------- ------- '/ ❑� Distance to nearest lot line-- -----`------------------- ------------------ ------------------s ----------------------- ----------------------------- b l Remodeling and/or rapairi q (describe):__ A _-rbP&IA4-:----------- ,f�---�-------�'�.�-p�D-----��------��JAG ''� ----------5/y, ��M------- ------- -------- �' __---- -__=_ _ = _ _= #------------------------------------------ ---------------------- -�r � _-------------------------------------------------------------------------------- -----------------------------------------------i------------------------------------ I hereby certifythat 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. (Signed).. -- ------------------------------------------------------------------------------------(Owner and/or Contractor r [Title) ------ -------- -- -- -- ------ Plot fan, showin size of lot,location of s stem _.. _o . Y,. ., -------------- ---------------- - - "�" � in reT lition to a Is, buildings,etc., canTbe placed an reverse stde�. P � g y FOR DEPARTMENT USE ONLY rAPPLICATION ACCEPTED BY-------•[__.k.R_0--- ---------------------- - ------------------------------------------ DATE-------- --- -- -------------- REVIEWEDBY------------------------------------------- - ------------------- --------------- --- -------------------------------------- DATE------------•----------------------------------------------- BUILDING PERMIT ISSUED" '' '" ---- = - = = .DATE------------------------------------ Alterations and/or r commendat' ns:. . - ----------------------------------- ------- -------------------------- Al ------- --- _.Z ✓I I"i. I jk;.4- ---- N\ -A----------- - ---------- --------------- --��, _-------- -------- ---'----- --- �'f` �.�------- -t�e ------------------------------------------ ---- �� - -------------------------- - --------------------- Date---- d�7� ----- ---------------------------------------------- SAN ------------ -- - FINAL INSPECTION BY:.._� .�.��- --- ��- { 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 r.a.co.