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FOR OFFICE USE: ? 4 ),- -------------------------------------------------------- --------------------------- --- --- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. _a.4Q.19 L --------------------- -- ---- ------ (Complete in Duplicate) This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Loca.L.Health a permit to construct and install the work herein described. This application is made in compliance with Coun3_e Thi 3dinat JOB ADDRESS AN4-LW.,ATION---- 6�e�----—--- Owner's Name--------- --------- ----------------------- ------------- -- - Phone---------------------------------- Address hone----------------------------------Address----------------------Av_,L ------ ----------- Contractor's Name--- --- --------------- _��-------- -----Nft�_*------=---------------- ----------------- Phone---4.4- Installation will serve: Residence gr-Apartment House El Commercial M Trailer Court [] Motel E] Other Number of living units- Nu 5_t' t size ---x?O Number of bedrooms,-_ mber of baths kk 0 --- --------------------- Water Supply. Public system E] Community system r ,�Ivltl' E] Depth to afer Table -------- ft. Character of soil to a depth of 3 feet: Sand El Gravel E] `Sandy Loam ;� Clay Loam E] CAy E3 Adobe E] Hard n F Previous Application Made. (If yes,date__.________________) N oIT w Construction: Yes E-'No El FHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifnfedsifg.public-.-.Sewer-4-is.-available-.w.i.thinw2OO4eeti,) Septic Ta Distance from nearest weli_ W_ --------D i gfa-�h c e frorro% ---- -------------Material--- -- --------------------------- =-1.1 S 11 e'10 No. of compartments-- ----------------- -Liquidjd6p ---------Ca pacify_42�--------- Disposal Id: Distance from neare(t we'ILWS D, t ff., f is afion D stance�*foinnear t I line____16:11,7-------- ye—0_ - -- V OT"C11 V eltpw wid -- --------- -------- Type of filter 71 Number of lines- Ay Len th of french. Depth OTAR rfiaterial---- tal length-------- --------755v?,409- ---------- Seepage Pit: Distance to nearest elL.-__ -i --- isfanceXornearc�t lot line--,--- -- ------Distan-�e fror�foundaflon_ D 0 77 _Z1 ElNumber of pits-------- L-ining material______------ _`_t___.__-Size: Dia�tea7r_ -------e"-----D,7qp t h,I---------------------I------- -3 t, I i"c m n >1 I ance from foundation------------------- ininrTMat-6'riaI___.. Cesspool: Distance f ear4sf wei� ------ ---Distc' ---- ----------- -I--------- Size: Diameter--- ----1.40 . i . El, __J-------- ---------------Depth.--- - - --------- ------------------�quiclkapacit. y- ---------------------- ...gals�_------------ - Privy-, Distance from nearJsf ;ell----------..... --- --- ------- ---------I----Distance from nearest i�wl�763------ - -------- --------- te Distance to nearest of line - - - --- -------- ----------------------------------- ---- ........................... -_-------------}---------- #5 Remodeling -------------- ----------Remodeling and/or repairing {descrlbe)e----- ------------------------- -------------11----------------------------------------- ---------------------------------------------1----------- ----------------------- -7 ------------------------------------------------------------------- ------------------------------------------- --- --------------------------------------------------- A---------- ke ---------------------------------------------------------- ----------------------—t�----��,f_ZA-------------------------------------------------------------------------------------- ---------- --------------I--------------------------------------------------- ---10----------------------------!------------------------- --------- I hereby certify that I have prepare d tKis 'application and that the work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations oftheSan,Joaquin Local Health District. (Signed---------------- --------------------------- ------------- ----(Owner and/or Contractor} -.1. ......... e r t BY:--------------------------------------- -------------------------- ------------------------------------------------------------------(Title}------t--- ----- ---------------------------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). .00-11 W FOR DEPARTMENT USE ONLY 00F_ W 2_ APPLICATION ACCEPTED BY------ -------- ---------------------------------------------------------- DATE.------------------- REVIEWEDBY---------------------------------------------- ------ - - ----------------------- ------------------------------------------------ IVATE-------------------- BUILDINGPERMIT ISSUED ------------------------ ------ -----MJDALE-------------------------------------- ----------------------- j ___'_ -------------------------- Alterations and/or rec6?nmenja+ions--------------------------- ------- - -- ------------------- --------------- ---------- I -------------------------------------------------------- ---------------------------------------- -------------------------------------- - ------- --------------------------------------------------------------------------------------------------------- -------------------------- ------------------------ ---------------------------------------- ------ -------------------------------------------------------------------------------- - ---------------------------------- ----------------------------- ---------------- ----------------------------------- - - ------------ - ------ --- ---------------------------------------------^j _V�-------------- -------- -------- ----------------------------------- --------- FINAL INSPEC� BY- _, . ....... ... --- ---- - Date-------------- ---- ------------------- E 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