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f-OR C..'FICE USE: r Permit No. ------ --- --------- ------ ---------- ---------------- APPLICATION FOR SANITATION PERMIT -------------------------- -------- -------- ------------------ -- (Complete in Duplicate) Date Issued This Permit Expires I Year From Date issued -------- Application is hereby made to the San Joaquin.Loca4 Health District for a permit to construct and install the work herein clescri.-bed. This application is made in compliance with Cbunty Ordinance No. 549, v---------- -------- JOB ADDRESS AND LOCATION-- z-- ---- hone-14"i - --------- Owner's Name---------------- --------------- ------------------- ------------ ----------0"6� Address--------------------- 7_y - - fl-------------------------------------------- - ------------------------------ __,c----a "I I-Al------------------------------------------------- ----------�7 'd - Phone ---------------------------------------------- ---------- Contractor's Name------ 4 1/ Other Installation will serve: Residence U31Apartment House E3 Commercial El Trailer Court 0Motel 0 ❑ Number of living units: --/--- Number of bedrooms __r-_ Number of baths 1... Lot size -_W Water Supply: Public system El Community system C3 Private 2--Depth to Water Table -,6? ft. Character of soil to a depth of 3 feet: Sand F Gravel 0 Sandy Loam 0 Clay Loam [ Clay E] Adobe[] Hardpan (R- No New Construction: Yes E] No E]--" FHA/VA: Yes ❑ No E�j` Previous Application Made: (if yes date----- . —.�T-Y-PE-OF-INST-A-L-L-AT-IG)N-A-ND rSPEC,I1FICA-T1ONS:--!1 (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) J� -----�ZwAlx-� !stance from nearest well---5-0-----Distance from foundation----/ -----.Material--- -1 0 Septic ..0 pacity-Z ----------- ;;L_ __Size Liquid depth-----` a �No. of compartments___------- ........ .. from foundoti n to nearest lot line-- ----------- Disposal Distance from nearest well j- 0.....Distance FV 'Number of lines-- ...... --- --..Width of french.- --------- -- -------Length of each line7 I/ -,,,2F4tr--7-!5 f*e-r---- --4--�p length Type of filter ma material- ��e Depth of filter mat erial-/Ip----- -- e fropn foundation--- to nearest lot line--- ------------ Seeve Distance to near --------D�stancrt est Size-. Diameter— ......Depth---- --JIF ---------------- �1 Number of pits------/ *1 e 0 ------------Lining maferial----T// Z-� 3 Cesspool: Distance from nearest well-___._.-_"---_.__Distance from foundation-------- ---------- Lin;ng material"..........Z-------------------- -----------------------Liquid Capacity---------------------------gal,, 0, Size: Diameter------------------------------- ----Depth----------------------------- . ... ..... Distance from nearest well_. - ------Distance from nearest building------------------------------ Privy: ---------------------------- ---------------- ❑ Distance to nearest lot lint_______--------------------------------------------------------------- ------------------------- 0 � Remodeling and/or repairing (descr�be):--- ---je0/1 /y --------" V ----------------------------------------------------------------------------------------------- ---------------------- a-------------- ---------------------------------- ----------- ---- ----------------------------------- --- --------------------------------------------------------------------------------------------------------------------------------- -------------------- *---------------------------h-------------------------------------------------- ----------------------------------------------------------- - I hereby certify that I have prepared this application and t at the work will be done in accordance with San Joaquin County el nd regulations of the San Joaquin Local Health District. ordinances, Stat I rules a w r and/or Contractor ----- -------s--- -------7-- {Signed]_------------------ -- ---- ------- J -- ---------- By:------------- --- ---- ----------- -- ---- - -- ----------------------- ---------- ----------------------------------------------(Title) (Plot plan, showing size of lot, loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE---- ---------------------- APPLICATION ACCEPTED BY- -------------------------------- -------------------- DATE--------- --------------------------------------------------- REVIEWED BY- ----------- ------------------------------- -------------------------------- - ------------------------ DATE. k--------------------------------- --------- BUILDING PERMIT ISSUED------------- -- --------- -------------------------------------------------T— 1> 7-t+ ----C? ---------------- ----- ----------�- ns*------ ---------------P1-----------OF- --I-- - ----- -------- Alterations and/or recommendatio ---------------5ANq-------- P 9Miq�x� -----m.). ------- ---- ---------------------------- --------------------------------------------------•-------------- --------------------------- ---------------------- ---- ------------ ---------------- ---1-,----------k- --------------------------------§-- ----------------D------------------------------------------------------------------------------ ----------- - --- 5 --------- ---- --- - ----- - --- --- ------------------------------------------------------------------------------------------ ------------- FINAL iNSPLL - ate- -- - - --- -.--.--.--.--.--.-.-.-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c:O.