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FOR OFFICE USE: - ?� d__k..c, ._ - Permit No- - - ------------ ---- ------------------------------------ APPLICATION FOR SANITATION PERMIT - 2.2 ----------------------- Fffff /.ZG o (Complete in Duplicate) Date issue /_ ___ _________ This Permit Expires_1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ( [ _J JOB ADDRESS AND LOCATION.._�t---I-----B_c� _�t-__1.21f�.4 Ui- a�'-�_ 1�4 OA) JOB Owner's Name-------------------------------- V�-_m� ---�-g- ------ `� --- ---- - - -- Phone--- `3 ----1 I�Q Address----------------•--------------------------------RA- _�----------- .�-------S-16-A--'---------------------•[-- TY---------------•---•-----/-•------------------------ Contractor's Name__------••---------------- - -�� -----------•`r --0----------------------------------------------- - Phone. �Lt?_.._f_ 7 Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms N7--- Number of baths A---- Lot'size -----#_00__z�®--------------- --- Water Supply: Public system ❑ Community system ElPrivateg Depth to Water Table 1v__`ft. Character of soil to a depth of 3*feet: Sand [❑ Gravel E] Sandy Loam E] Clay Loam A Clay ❑ Adobe [-] Hardpan ❑ Previous Application Made: (if yes,date____________________) No�& New Construction: Yes ❑ Nom FHA/VA: Yes ❑ No TYPE OF :INSTALLATION-AND SPECIFICATIONS:-- (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-----.-------------Material------.--------.._._____.____________.__________- ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------- ----Capacity---------------------- --Disposal Field: Disfarce.from nearest well. __..._.Distance from foundation-. -------Distance to nearest lot line---t5_1______ � jj Number of lines-------------___)----------.------Length of each line------- trench..:__.:..___4._ ___.__._____-_:_" rt -�{ r Type or filter material___--- . _ _ _Depth of filter material------�8__--_-____--Total length______7,-57__1_____________________ ' 1 Seepage Pit: Distance to nearest well___--------_-----_----Distance from foundation--------------------Distance to nearest lot line_________________ D f ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------...---Depth-----.--------------------------- Cesspool: Distance from nearest well-------------____Distance from foundation-------------.------Lining material----.-------------------------------- A ElSize: Diameter--------------------- ---------------Depth---------------------------------------------------Liquid Capac:tY--------------------------•-gals. Priv Distance from nearest well____________________________ __._Distance from nearest building ❑ Distance to nearest lot line------ -------------- ----------------------------------------------------------------•-------------------------------------------------- ---- RemodRemodeling and/or repairing (describe)------------- � �- A) -- eling -------------- Nsr_______!� __ ,________________ ---------------•-------•---------------•---------------------------------------------- -----------------------•-------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------=--------------------------------------•-------------------------------•-------------------------------- ---------------- ----------------------- ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and-mqulations of the San Joaquin Local Health District. (Signed) ------------------------------------------------- - --- ------- �44_ ---------------------------------------------------- Owner and/or Contractors (!�„ „G (Title)------- -- '---------------- ----- ----------------- p ____________��___________________-____ _-__.-___ _ ____ ____.______.__.____________.________________ ________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------------------------------------------------- DATE_ .� - ---- --`�-- -- -------------------- REVIEWED BY-------------------------------- . . -- -------------------------- ---- DATE----------------------------------- ------- -- - - -- - -- ----- --------------- BUILDINGPERMIT ISSUED------------------------------------------------- -------------------------------------------------- DATE--------------- --------------------------------------------- Alterationsand/or recommendations----------------_---------- --------------------------------------------------------------------. ----------------------------•------------------------------- -----------------•------------------.....----------------------------- -------------- ---------- ------- -- --------------------------------------------------------------------------------------------------------------- - - --------------------------------------------------------------------------------------------------- --- ---------------------------------------------------------------------------------------------- I FINAL INSPECTION BY. -------------------- Date------/ (`' ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.C 0.