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FO OFFICE USE: �a APPLICATION FOR SANITATION PERMIT Permit No. .....l_ y----_ - -- -------- --- - ----------------------------- -- -----`-_. ---------------------------- -------- --- --------------- (Complete in Duplicate) 1' Expires 1 Year From Date Issued Date Issued ._ This Permit Ex -T 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. 544. /� JOB ADDRESS AND CATIcON---------3-�o--j-------W--•- yQ ----------------------------------------------------------------- --------- ------------------------------- Owner's Name----------- �s3 _ ------- -. Phone------------------------------------- Address---------------------------------------------�- 0A-------.,-•�- ---------------•----------------------------------•------------•---------•-----------------------=----------------.- Contractor's Name-------I.R.0d-ka.--- aRa.-�T- -------------------------------------------------------------------------------------------- Phone----••---------------------------.. Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�.__ Num er of bedrooms _ Number of baths ---I... Lot size ___ _- -----__�_.5�' ------------------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table 4A`7t. j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa [j Clay Loam ❑ �Cla�y ❑ Adobe C]r pan Previous Application Made: (If yes,dote--------------------) No. ew Construction: Yes N__l ❑ FHA/VA: Yes ❑ No [ j f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well--.-'—__Distance from foundation---/�-------Material_--- ------------------------ 20 No. of compartments------- C"'r - ---Size--------------------------------Liquid depth-----$0__--------------Capacity-_ 1.0-0-------- Disposal R Distance from nearest w I._.'----____Distance from foundation,__10----f--. -.Distance to nearest lot lioe�.-_____. Number of lines_____________ Length of each line___.___. ___+�.___---- ----Width of trench+�. __..._........... . . Type of filter maferi_ �C -kT.---Depth of -----_.Total length-----F41__-'0------------------ Seepage Distance to nearest well.. ............ _Distance om foundation-----J-40-1... Distance to nearest lot line_s�__... �1" Number of pits------ !_-.__-----_Lin g �. material__� L �..Size: Diameter ,S ...-........Depth_mrxZ�--_- Cesspool: Distance from near st well-----------------Distance from foundation--------------------Lining I E- material--.-----____---.---..-_________---. 1--`Li uid Ca acitY � gals.Size: Diameter Depth 5 ----- F 1 Privy: Distance from near'st well---------------------------------________________Distance from nearest building----_____.______r__-_-_____- -_-.___... [) Distance to nearest)of line ------------------ ----------------------- ---------------------------------- ------------------------ LP Remodeling and/or repairing Idescribej� ----------___fit,__-._ -- _______- S- v-1- -- _ p.. -------------------------------------------------------------------------- ---------------------------------- --------------- ---------------------------------------------------------------------------------------------------------------------- ------ -- ---------- ---------- - ----- - --- -- I hereby certify that 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}L'ocal Health Distrie�.1_4. (Signed)--------------- ------- By___ ----- -------------------------------------------------- .--------(Owner and/or Contractor) By -_ -�------------------------- � ---------- - ------------------------(Title)--- ------------- -- (Plot plan, 'showing size of lot 1 cation o .'system in relation to,we s, uild'+ngs, etc., can be placed on reverse side). .i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- .- --------------------------------------- DATE--/ ----------------------------- REVIEWED ---------------------------------------------- REVIEWEDBY----------------- --------------------------- -------------------- ---- --------------- -------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- DA�E------------------------------------------------------------- Alterations and/or recommendations -- : -`` -��^�`� ��-[�`G� �------`�'1-'---L`-��i7---------•--------------------------------------------------- -------------------------------------------------------------------------------- ------------------------------------------------------ --------- -------------------------------------------------------------------------- ---- •-------- -------------------- ------------------------------------- ----------------------- --- ----------------------------------------- ---------------------------------------------------------------------- %3 FINAL INSPECTION BY: ��' �- ----- ------------- ------ ---------- ...... Date .SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maaelton Ave. —300 West Oak Street 'A *1'24 Sycamore Street 205 West 9th,Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.co.