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FOR OFFICE USE: J} G f �"-� - ----- --------------------------- APPLICATION FOIL SANITATION PERMIT '57(, Permit No. . � ----- (Complete in Duplicate) Date Issued------------ --------- ----- ----- ---- - ----- ............. This Permit Ex Cres 1 Year From Date Issued Application is hereby made to the San oq i Local Health District for a•permit to construct and install:,t work herein described. This application is ma n compliance wi ht 0rrdinag5e No. 5.49. e L� JOB ADDRESS A t CATION_;� - - "-v- ;..� --- I Phone------------------------------------ .. ---------------------- Owner's Name ----- --"- -- - '- - - - ----- ------ --------------------- -------------------- Address-------•----------- „ -- - ----- - Q�7Q ! C_'_,I��d - % ------ Phone-X74- Contractor's Nam - -... Instaliation will serve: Residence rtment House Commercial ] Trailer Court [:] Motel [:] Other ❑ Number of living units: __ ----- Number of bedrooms J.- umber of baths _ mot size ___... Water Supply: Public system El Community system Private ❑ Depth to ater Table -------- ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑�. o Adobe ❑ Hardpa ❑i _ - �.. ....Previous Application Made: (If yes date_""'"""�"- ') No ❑ ewonstruction: Yes ❑ FHA/VA: Yes No ❑ 11 M � t TYPE OF INSTALLATION AND SPECIFICATIONS:,, ( P _ ' ' feete • �""'" .„ � .'Holi - ------------ --- --- No septic tank or cesspool p rmltted if.pubft 'sew'er, aMable within 200 Septic T Distance from n crest we_11:7�.�,C! -Dlsfante fro faun ajLl _--� _.__.-..M la __ # € ` 'x ° �F t 'uid depth 57-4 1 -Capacity--•/��--� No. of compart en.ts_ __ + -...__Sizer_ --- - q P. P�r � %i f aldn__�-" _._ istpace to nearest la lin --1 Disposal d: Nlumber ofol nes m narestwe�lf .--�'Dengof reac .pline ._ - - lath"of # ench----_ ----------- --��- - r Type�of-flier maters --Depth of filter mater,al EP ----_.-Total-.,,,length_-_-_fQ�..__. ___.._____:_c_._ r� -Dista cn e from found #lo°n _�"S's-.----'Distance.to nearest lot Ione_.. - Seepage Pit: Distance #o near st well- Y .____.k __ „ _ ,: ) a4 tn ❑ Number of pits- ------------I, --Linin. materiaL----=:.------ - - -----Size#iJiame�er. -.? ;� ePtn " -i 1 Cesspool: Distance from n�arest will--.__�`--------rDistance,from foundation__________ ---------Lining.;mat nal_-..__ ._..____:..__,_,_ ❑ Size: Diameter ---------;-- . Depth i'fl------------------------------ -__.Liquid Capacity------------------- gals. Privy- Distance from.nearest well-----------F _ -_._Distance from nearesIding _ ._.._. -- - I ❑ Distance to nearest lot line---------- ---------- -- f 1I Remodeling and/or repairing [describe):------ -- ----------- --------•-----------------------------------------=-------- --- ----------------- -------------------------------- i •---------------- -- ---------- ------------- ------------------------------ --------------------- --------------- ---------------------------------------------------------- ----------E --------------------------------t------------------- "._ - -."ri• - ,:_,.. = ----------------------------- ----------------------------------------------------------- ..,.�__ _,,�..,„ k I hereby certify that I have prepared this application and that the wor will be done in accordance withSan Joaquin Counfy ordinances, State laws, and rules and regulations of the San Joaquin LocalfHealth District. e J4.. Q.�" J'C 1- ------ --- -- --------------- --- Contractor) (Signed) By;_ ------------------- (Title)------------------------- -- ---------------------.--- ----- (Plot plan, showing size of lot, location of system in relation to ells,-building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I �� APPLICATION ACCEPTED BY---------f ` �o------------- -------------- ---------------------------------------- DATE-------rte. ��..._.. --- . REVIEWEDBY------------------------- ------------------- -------------------------------- Y== -------------------------- ---- - DATE------ ------------------------------------------- BUILDING ---------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------,.,,.-�_%------------------------------------ DATE-------------------------- ---------------------- ---------- Alterations and/or recontmendations:-------------------------"------------- --- ------------------------ -------- -------------------------------------------------------------------------- ----------------------------------- ------------------------------------- ----- ---- --- ------------- --- - -------------------------- ------------------------- -------------------- --------------------------- i FINAL INSPECTIO •- - G `� - - 3 Date--------------------- --------------� --��' i 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.0 O.