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FOR OFFICE USE: ----------------------- • � ~ APPLICATION FOR SANITATION PERMIT Permit No. a �:�: - ------- (Complete in Duplicate) . . ..-.� .r Date Issued ..............:............................................ "Tfi'is Permit Expi�es`1'Year From Date Issued i Application is hereby made to the SanJoaquin Local Health District for a permit to construct„and install the work herein described. j This application is made in compliance 'with County Ordinance No. 549. JOB ADDRESS AND LOCAT ON �^ --------- ----------------------------------- .� I _______` --�------ - �-- ------ Owner's Name /f' ..........................r4 1 ----------- Phone - Address------------------------- lQ :... a745T_?�% g jContractor's Name--------22 r/ "t /7--- - --------------- Phone_J installation will serve: ResidenceApartment House ❑ Commdreial ❑ Tr(ailer tCourtl ❑ Motel C] Other E]Number of living units: _/ Number of bedrooms _/V16"m b�er of b Jths __•f Lot size ----------------------d----c-------------------------------- Water Supply: Public system Community system E] Private 0� Depth to(Wafer Tade -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel L] Sandy Loam [ CIayvLoam 0 Clay ❑ AdJbe,j Hardpan ❑ Previous Application Made: {if yes,date............ . ) Nom❑. � Construction: FYes [I No E] FHA/VA: Yes E] No E] V`1 i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe nutted iflublic sewer is available.within 20. feet.) O Septic Tank: Distance from nearest well-----------------Distance from foundation _-----__---.Material____._._-._._-�,l.._�-------.-..--.-.-.-----__._. ❑ GC�b� P ---------Size------------- Liquid depth ! ------------ ---------Capacity-------------------- --- `” No. o com arnce from neares-- ell * ce-frorritffoundatio -------------------?Distance.to neares lo#'line!!�__._.____. Disposal K,eSdk Numberr of lines-----—wel Lan t., 54 0 � __D.istanh =oeachAline.__:_ - Width of trench- -. . r a�--- D�eA fih'of filter tery al=,- ---- � - 9 Type of filter matenal_�_- �__' p _ w_ q ..��------/�otal length----------- --------------- Distance ------------- f / ' Seepage Pit: Distance to nearest well---_=.-�-------_.--Distance from fo ndation,__._� D�stance to nearest lot line-., __....._ v ❑ �3C�ST• Number of pits-- _j _. Linng:_rria#;eraL / . �___ : Diameter-_- ��-_____Depth... ��_____________� Cesspool: Distance from nearesf weiL.-____.____,.� D.istatree from4faundatA-1 -----------------!Lining material-.-.--- --.-. _-----.:Size: Diameter.___..-- - De th_____________`- Li uid Ca lcit ----- als. -- -------- ----- p -----_ --- q P Y = 9 Privy: Distance from nearest we1L------------------------------------------------Diatance, from newest building-__.-.------�-.--._.-.-..--..-_--... ❑ Distance to nearest Iodine._._- ---------- ---•------------------- _ - ------------ C Remodelin nd/or epairin escribe) f,' a? -�----- r / ------ �. r _ * ---------------------------------------------------------------------------- = I hereby certify-that.1..have-prepa recf this application=and that.the..work.will..be-done in accordance .with San Joaquin County ordinances, State laws nd rules and re ulations of the San Joaq iL- -1 Healf, Dist iC ct. "1 w (Signed)--- -.._._.( r and/ar Contracfior) �- . Bri------------- ---- - ---- -------------------------(Title)----------- �..--- (Plot plan, showing si a of lot, oca ' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED gY----------- ---'------------------------------------- ---------------------- DATE �Q f�� REVIEWEDBY-------------------------------------------------------------------------------------------------------------------- --------- DATE------------------------ ---------- BUILDINGPERMIT ISSUED----------- ------------------------------------------------------- -------------------- --- --------- DATE------------------------------------------------------------- Alterationsand/or recommendations--------------- -- --------------- ---------------------------------------------------------------------------- -----------------•------------------- ------------------------ ------------ -------------------------------------------------------- ---•------------------ 1t- -------- -I----- --------- --------------------------------------- - --- ----------------------------- --------------------------------------------- ------- ------------------------------------------------------- C AFINAL INSPECTION BY:..--.. --- .-. ---- Date-- ------- ------- ---------- SAN - --SAN JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Califofnia Lodi, California Manteca,California Tracy,California