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*ti R.QFFICE USE: ------- APPLICATION FOR SANITATION PERMIT Permit No. - ----------------------------------------------------- --- ----------------------------- - ----------------- ------- (Complete in Duplicate) Date Issued -----------------------------.------ This Permit Expires 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.. � - �0 /I/fJOB ADDRESS AND LOCATION------ - ----- = ------- ----------------------1r A ---•---------------------------- Owner's Name---------------i ---------P3----- ---Ba ` H_, R�r --'------------- ---- --------.'-,- Phone------------------------------••---- Address---------------)��7F----`--2--`-----...V--1.0-.----------•-t��0. 1111_QCV_ T / Contractor's Name__j0W/VJ[5;� =------------------------------ ---- ------------------------------------------------ Phone...... .--------------_---------- Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other4❑ Number of living units: _l------ Number of bedrooms - _ Number of baths -2- Lot size _-. -----<---- ��-1--- `----------•- Water Supply: Public system ❑ Community system ❑ Private,E3--Depth to Water Table __;7 ft. Character of soil to a depth of 3 feet: Sand.®Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (Ifyes,date---------- -------) No ID' New Construction: Yes ©--No-❑ FHA/VA: Yes ❑ No•❑- TY-P140F1.INSTALLATI.ON.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---570-----Distance from foundation----IQ_-------M,a/ter- I__..COAJCR T ----------- No, of compartments------ .--.------------Size4/x)_ :x_-S-----Liquid depth---- . ---____Capacity---,j�� Disposal Field: Distance from nearest well.--5-0..._.Distance from foundation.--/(.2---------Distance to nearest lot line---.--5--_---- [ Number of lines------------------------------Length of each line--------- - _- ��---.Wi th of french.--_---_361 ------------- I Type of filter material--_- --Depth of filter material-----/<----_-_..Total length--..------- - _W-------------------- Seepage Pit: Distance to nearest well------------------ Distance from foundation__--_-------_-----.Distance to nearest lot line.---_.-_-._----_ El Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------...Lining material-------------------------------.-----. Q ❑ Size: Diameter----------------------- -Depth------------------------------------- - ----------.-Liquid Capacity----------------------------gals. 4 Privy: Distance from nearest well---------- ------- --------------- - -----.-Distance from nearest building--- --------------------------- ------ Distanceto nearest lot line- ----------- ----- - -------------------- ------------------------ - ------------- ----------- -------------- --------- - .t Remodeling and/or repa.i,,ing (describe--------------------------- -- ---------------------------------------------•-------------------•-------- -- ------------------------------ --------• 0 r --- - i i _�_. == _ --------- ------------- --------- - ------------------------------------ ----- ----4------------- ------------ a ------ `� I hereby certify that ! have prepared this a lication and thahLacalkhiealtheDtstr District. Nf ---------------------- ------------------------ --- Y y P P pp n a cordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquint ' J _ 4 • �- z �_w r f--- (Owner and/or Contractors (5lgned�- - ------------- = g . = - r — -------------------------------- (Plot ------------------ ------ ----- r (Plot plan, showing size of lot, location of system in e!a#iOngtoYwelis;-buiidingss,,etc:;rcartrbe pl c d on reverse side). FOR DEPARTMENT USE QNLY-- - y- Q ., -- _..DATE-_ 7--_-_7 �- APPLICATION AC_EPTEE BY •( ' ;�r ---------- ------ ------------- ------------------ REVIEWED BY----------1-- - = ------- - ---------------------- ----------------------------------------- DATE ` - ------------------ BUILDINGPERMIT 1SSUED------------------------------------------------- ------------------------------------- --- --------. DATE------------------------------------------------------------ Alterations and/or recommendations: -------------------------- -------------------------------------------------------------------- -- --------------------K---------------------------- At Q -----------_------------------- ----------------- ------------------------------------------------------------------------- -------------- ---------------------- ------------------------------- ----- ------------------ ------------------------------------------------------------------------------------------- ------------------ ---------- --------------------- ---- ------------ -- ----------------- ---- ---- -- ------------ - - - - __, � ------ -: -------- - ----- ------ ---- -�-- - .:s.0<!w""#° tf'!'� ._,� � 5r�,�' � •, •1"{31 ...r FINAL INSPECTIO � .. - Date SAN JOAQUIN LOCAL HEALTH DISTRICT �-- -- 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5tocklon,California Lodi,California yManteca,California Tracy,California F.P.Ca.