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FOR•OEFICE.USE: APPLICATION FOR SANITATION PERMIT Permit No. ------- ----------------- ------------ - (Complete in Duplicate) w. Date Issued -------------------- -- ---------_-------------_-- This Permit Expires I Year From Date Issued - Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and.install the work herein describe This application is made in compliance with County 7Ordinance ��No-��TT�_____�p-_._��--/--��- �� , S t D - I t ---�----Mulaf� JOB- ADDRESS AND LOCATION_: _ �___.>� C ( _ I - :, s ,� .- ,�- -------- Owner's Name_- :-�Y-I •5 ��--Tfl ��- - 1. 1' M T Phone Address------ * �C - -----•-- = --------------------- Contractar's Name---- Installation ame i+ 11- --------------•--------------------------------------------------- --------------------------------------- Phon ---------- ---------- N,)R51 NG^ Installation Will serve: Residence ❑ Apartment House ❑ Commercial El'Trailer Court ❑ Motel ❑ Other ❑ HOM 19CS------------------------ Water ---------------------- Number of living units: _-- ___,,Number of bedrooms �__ Number of baths _-3__ Lot size _______________________�----- Water Supply:. Public system•❑ Community system ❑ Private ❑ Depth to Wafter Table ........ ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ ;Adobe ❑ Hardpan ®` Previous Application Made: {If yes,date________ ________) No New Construction: Yes FHA/VA: Yes J_ No e— TYPE OF INSTALLATION AND=-SPECIFICATIONS:-w- a Ft ,(No septic taAk or4ces:esss'pool pert�itted'if,publlcei'wer is available within.200, k Septic Tank: Distance neareswe Dft well Q-.___Distance from foundation --��----- Material �oilJcj �-T� ---------- I - p-�of compartments----------2-- - -- -----Size_SX_�_-1--_X-5--Liquid depth----� Capacity___ - ti.l�l Disposal Field: Distance from nearest well---- �1___-Distance from founds ion__l�___-.--__-Distance-to nearest lot line__..____-__... z - ----- Length,of each linefVyidth of trench-------2V-'l�l ,--. W Nurrlber.of.lines.-______ - :. /�d t Type of'filter material _.�iCQ�.� �'D�pth of filter material_ .�__� -: Total le'rigth _________ -______ Seepage.Pit: Distance. to nearest well_.---/D�7------_Distance from foundation_��-__-___ --:Distance tolnearest lot line________________ +ti �, fDe to - .-> IJ' �-� Number of pits------ matenal__I��J-G;�'_ _..__.Size: Diameter._____. Depth - 1 A j _�E h' -.y + Cesspool: 1 Distance from nearest well----------------- from foundation__..._ Lining material_ Size:--Diameter---------------------- --- --------Depth--------------------------- --------- Liquid Capacity gals. ❑ i � - Priv r Distance from nearest well__________________________-__--___ -_-________-Distance from nearest building......... ..................... _.......... Y :: ❑ } Distance to nearest lot line---------------------------------------------------------------------------------------------- ------------- -- ---------- = 1, �T?1? T� - X_tSTi G S T n{( �'�=ISS------ a !_TT'Prj Remodeling and/os repairing (descri e):____ _ 5---------.. :,' - I r_ ---------- -----IBI1 f�(C=---------5y_ ---------ro-------- D1 --`---------------- ------------------ -- 1 -------- - I hereby`certify that I have prepared this application and that the work will be donetin accordance with San Joaquin County ` ordinances, State laws, and rules and regulations of the San Joaquin Local Health District n / , (Signed) `-' v------� - ------------------------------------ ------------- -.(Owner and/or Contractor) 6 -----------------------------------------{Title} --- - - -- setc.,�can_b , placedonv ; _IPlot. Ianrhowing size-.o _o ;_ocaon-osys - relationto w_eIIs;,buiIdings,_ e - s � I FOR DEPARTMENT USE ONLY J ;y APPLICATIONACCEPTED BY.. 1.J ___ ------------------------------- DATE---- REVIEWED BY------------------------- --- ------------------ DATE BUILDING PERMIT ISSUED--•---------- ------------------ - ------------------ - - DATE - - Alterations and/or recommendations------------- Y --------I----------f-------------•.----------- ------------ = ----- �� -----`--�_- �� Op ` t - i --------------------- ------------------ ----------------- -----------------------------------------•------------------------------------------------------------------------ ------- _--_ - ----- -- --------- ------------------------------------------------------------ ----- --------------------- ---------------- ------------------ - - ------ ------------- ---------- ----- -------- -------------------- ---- - ------- _ l �-- � / = S FINAL 1NSPECTIO1tl�Bx -- .- - - --- -- Date................../- ---- -- ------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 203 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California 41 r.p.c❑.