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APPLICATION FOR SANITATION PERMIT 2 Permit No. f (Complete in Duplica+e) This Permit Ex ires i Year From Date Issued Date Issued -___j �� Application is hereby made to the San Joaquin Local Health District for a permit to torts This application is made in compliance with County Ordinance No. 549, construct and install the work herein described JOB ADDRESS AND LOCA 1ON_-, ' � � x/11_1 � ------1_q&k�_ ------------._.. - _ f Owner's Name_ _ ---�77_ - -- - ------------------- Address---------..,1 -Q--------------------------------------- w0 � fJF Phone ____ R r�CRs �� , ---------------------------- ------Contractor's Name----- ------------ Installation will serve: Residence - ------------• ---- ------------ • -------•-- Phone---•-•-----� � partment House ----------------- Number --------- ---•-_ Number of living units: ___1 Number of bedrooms Commercial ❑ Trailer Court ❑ Motel ❑ Other Cl Water Supply: Publics stem Number of baths -_1._._ Loft size ---/% ------------------------------- Character Y ❑ Community system --------------------------•- Character of soil to a depth of 3 feet: Sand Private, qFuQ' Ater Table - O 1__ ft, ❑ Gravel [] Sandy Lo Loam Previous Application Made: _[It yes,date_----- Clay ❑ Adobe ❑ Hardpan []TYPEOF INSTALLATION AND SPECIFICATIONS: No New CYes I �rNo'❑ FHA/VA: Yes ❑ No (No septic tank or cesspoolYperr i}}bd-if'`publiG sewer is available wi4liin' 20Q-feet -.: Septic Tank: p Distance from nearest weir �- " Distance from foundation__f0_---_-_ ®'r No, of compartments_. ,`�- - ,..�� Material_-___ - -------------Size---� -`_—%-' ---------------- ------------- ------- Disposal Field: Distance from nearest well. O / 9--Liquicl depth__-�.-_-_-__- Capacity_/�b� --_.-Distance from foundation._�O_<_ Distance to nearest lot line_`_' Number of lines___--�________ ___ Length of each line____- ,�• ' Type of filter material------.� --Width of trench-_ _ - Depth of -Filter material----f-___.-- Total lengfih_--__.__ --------•--- Seepage Pit: Distance to nearest well ___ _Distance from foundation__,______- __ ----------------- ❑ Number ofypits-------•---------------Lining material-----------_-- Distance to nearest lot line-----------__--- Cess ool: -------..Size: Diameter------------- -------,Depth_. - ❑p Distance fiom nearest well,_.____-- -_Distance from foundation----_._.-_.-_ Lining material__.._-_,---_- _ t Size: Di ` --- --- _ _ . . ameter. -. - -- Depth- Priv _ •..x .- Liquid Capacit Y Distance fromnearestell "•� _ - • F, Y - gals. .d., ,. r ---.Distance from nearest buildin Distance to nearest1ot line � ,_ ' -- --- -- - -- -`- � qtr g ---- �---- ----- -----------'""�""`"�`. _„� -------- ----------- •H - - ----- - ----------- ,;_Remodeling and/or repairing [deicribe):_-- - ---------------------------------- -- _____________.__-__ 'y---------------------------------- -- _ ___ _____ ___________ _ ------------------------------------------------ _ __ ___ r ______ ______ _. _ ___y._________ hl^y 'T --_ -----_ '.... .--____ ___________---_._ _.__ „ __...___________s------------------------------------ _ "•' ti s -____---_-- __--•-_- _____-..- __--__.___.__ -.: _ i __________ hereby certify that ! have sprepared"this application and that #•�h work will be done in accordance wit ordinances, State laws, and rules and regulations o the San JoaquinCocal Health District. h San Joaquin County 5 ' (Sig_ned)----- __--___._- 6 Al ---------..... ... .. .... _ _ ....�. gy;- ` = } wner an r ontr --� �O d o C ` - _ Title _ / attar) (Plot plan, showing siz f lot, location of sys;em ine ion to w.ells; buildings, etc.; can be placed on reverse side). ==------:_ FORIDEPARTMENT USE ONLY " + r4 ` '�P. r I --------- ---- + - APPLICATION ACCEPTED BY____.--.--__ -REVIEWED BY ----- - -- - - I ! DATE - -�---- ---------- •-------------- - --------------------------------------------- 'BUILDING ,•'„ -- � -_`.fes . PERMIT ISSUED-------------- .............. --- ;� ---- DATE__..----------- ------------- =� � -----`- Alterations and/or recommendations=---------------- 1 j�_._ - DATE.--_-------------- ------------ ------ � ---------- l� ------------ --------------- -----•-----•----- -- ------------ ---- ..`tea'►y -------- ------------------- --------------- ------- - FINAL INSPECTION -- ----- Date--- 1601 E.Hazelton Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT . 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca, 205 West 9th Street California F.P.CO. Tracy,California - i