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R OFFICE USE: ---- , ars APPLICATION FOR SANITATION PERMIT -Fermi+ No. _.�l5_d__ - --------- '-------- --------------------- (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 construct and install the work herein described. This application is made in compliance(with tCountyOrdinanceNo. 549. 1 - ,r -- ii / x�-- J _.< --'`--------------------------- -------------- ------------------------- JOB ADDRESS AND LOCATION j Owner's Name---------C44-1,,& •---- Address ---------------•----------•----------------------------•-------------------------•--••----•• --••---•---- .......f i r Contractor's Name--- -- - ----•--:- ;- �`- � _o l _ Phorie _- �1 Installation will serve: Residence Apartment House [ Commercial ❑ Trailer Court ❑ Motel p Other ❑ Number of living units: --1----- Number of bedrooms Number of baths -------- Lot'size - �?-- - _•3 �3-[ -!"ts_a^.L�� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _A-5ft.7— Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------- --------) No [,r -_�'_New Construction; Yes Ea--No ❑ FHA/VA: Yes ❑ No R-" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed'if public sewer is available within 200 feet.) .` $ 0 � Septic T r:k: Distance from nearest•well- �' ---Distance frorf�foundaytion___�-_-_--._'----.M ripl----. No. of compar#mems---.- ---- ----------Size-- --- Liquid depth_„------------------------Capacity---- --- Disposal Field: Distance from nearW. est . e�_ -----Distance from founds �0 1� ----- -.Qi ante to nearest lot line---- -_---- ,> Number of lines_-----__t'( ------ -------- of each lin' - -- -- -. hof trench--.-- ----------------------------- Length . ca Type of filter material4'V_ ___6(/1�Depth of filter material------ --'r�---_Total length_-_------ASO---------------�.- � Seepage P• Disfance to nearest�,eli.__& ------_Distance from foundation----11--'"-_-.Distance to nearest lot❑ line------- � • r s�1SNumber of pits.---_ _____ -.-Lining material___ -3%33 s ----Size: Diameter f __ ------__ - Cesspool: Distance from nearest well------------- from foundation--------------------Lining ❑ - ma#erial--------____-----__--____.___=-9--a--�-s'- Size: Diameter-.----.-._-_' ----Depth---- --------------------------------------------Liquid Capacity- ----------------- -----;_ ---- .. to Privy: Dstanr from nearest We'l----_...--`-------------------------------------Distance from nearest building ----------------------------------- i ❑ Distance to nearest lot line------- ----- - -�------•---�� r _--------------------_-------____------ 5 .Ct - Remodeling and/or rilpairing (descfibe):----- ------------------------------------ =, r{ ---------- -•-------- ----------------------•--•---------- ---------------------------;--------------------•-------------------------------------------------------------------------------- -- I hereby certify that I have prepared this application and that (fie work will be done in accordance with San Joaquin County ordinances. State laws, and Wegulafionfthe n Joaquin Local Health District. (Slg ed) --`-'_------•---------------- -- ------------- ------------------ --------- -- --------------------------------(Owner and/or Contractor gY••------------------------------------------------------------------------------------- ------ --------- - - --- =°--�- -- (Title)---------------------- -------- (Plot plan, showing size of lot, location of system.in,relation to wells, buildings, etc; can be placed on reverse side). d FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ---------=----------------------------------------------------------- DATE------- &7------------ REVIEWEDBY------------------------------------------ ---------------------------- ---------------------------------------------------- DATE------------------------------ L. BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- ------ DATE------------------------------ ------------------------------ �.r Alterations and/or recomme dations----- - ------------ -- - �- --� ---4 ..... - -------------------- - ------------•-------- -•---------------------------------------------------------------- 6 ---------------------_------------------- --_-_---_-------------- ----------------------------------------------------------®---------- --------------------------------------------------------------------------------------------------------- ----------------------- --------------- FINAL INSPECTION BY:-.-.-..... --------------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California r:a:c o. - t