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3FOR-C)FFI)CE USE: 7PA_7�-------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ---------- -------------- - A (Complete in Duplicate) ---------------- --------------- - ------ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION_.__/_Z�_4/X-----&d1__z_a_ ------------- - -----------------------------------I--------------------------------------------------- Owner's Name--_---c . ....... ----------------------------------------------------------------------------- Phovo---- �Y <_ Address-----------------•------1- , ;d52 I -----------............. ------ -----------...... -------------------------------------------------------------------------- Contractor's Name--- -------------I--------- Phone----•---•- ------------_---------- Installation will serve: -Residence M-"Apartment House R Commercial E] Trailer Court F] Mofel E] Other E] Number of living units: J---- Number of bedrooms Number of baths _/---- Lot size. ---------------------- Water Supply: Public system El Community system E] Private 2--�:Ue'p+h to Water Table 4-0 ft. Character of soil to-a deptliof'3 fedi-Sa_ncl [J' G�a`,,-;el [] -Sandy Lo'a- pan Loam I-] Clay Loam E] Clay 0 Adobe P_<ard Previous Application-Made: (If yes,date--------------------) No ❑ New Construction: YesEJ No W E] No Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) r ---------- S fi. T r1k: Distance from nearest well-----------------Distance fiom foundation ----------Maferiai------------------ --------------------I r ......... . &XII-1 No. of compartments--------------------------Size----------------------------._Liquid depth---- ------------------- -Capacity---------------------- D' , / - .. I Di Distance from nearest Disfarice from foundation---. ....Distance to nearest lot line- ' 4- Number of lines_-___ ___ _ Length of each line-- 0--!� -----------�Wiclth o9trench___ �__-�` -!� -------- /01e-- - --at Type of filter m eHal ----Depth of filter material--_ --- -- --Total lenth------------- -- ------ Se e Pit: Distance to nearest well_/_0_&'___,__Distance from foundation___.___. "__Di t ce to nearest lot line...... Number of-pifs-----L."----- -___Lining material-k-'p, 0,of --------Si-,e:4'D;a'mefer.... 1Zx -,WST ....... .Depfk- --------------------- Cesspool: Distance fr6m nearest well--------------_Distance from foundation___-_-_._._-._---.1ining matE�rial t 4. -------------------------------------- El Size: Diameter________________________ i ----------------Depth--------------------------- Liquid.Capacity--------------------------- ------- - --------- gals. Privy: Distance from nearest well- -- ---------------------_______--Distance fl�onn nearesf"buiiding---------------4--------------- ❑ Distance to nearest lot line---------------------------------- - ------------------------------f ------------ ------------------------------------------------- ----------------------------------I-------------l-e-.---4----_--_----.---- --.-------.------- ---------- ---------------- ---- -------------------------I------------- -------- -------------------------------------------- .-.--.- Remodeling and/or repairing (describe):-------------------------------------------- -------------------- I 3 - .-.-.-.-..- -- t ------- ----- -------------------------------------- tr0--- ------------------------- ------------------------- ----------------------------- --------- ----------------------------------yf__ I 'r ----------------------------------------------------- ------------ ------------------------------------------- -------------------------------------- - ----------- I hereby certify that.1 have prepared this application.and-tat-Jhe-work wj'll be done in accordance with San Joaquin County ordinances, State laws,,and roes; and regulations of;$e San 'Joaquin Local alfh District. (Signed)- A10��r Confiacfor) ---------- ---------------------------- ...... . . By:---------------------------------------------------------------------- (Plot plan, showing size of lot, location' wells, I s, e --- ------------- --------- of system in.re-l-aii----�tM; ---bui in s, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------ - ---- - ------------------------ ---------------------------------------- DATE------7"1'" REVIEWED BY------------- ; /- �------------------ ------------ DATE - ------------------------ -------- ------------ --------------------------------------------- ------------------------------------------ BOILDING PERMIT ISSUED-------------------------------------- DAT Al4rafions and/or recommendafions:__175=�,,�___� -- -- ------- -,T/ z--------- ------ -------------------e-7-------- --- ------------------------- ------------------------ ------------------------------------------------------------------------ ---------------- ------------------------- ------- -------------------------------------------------- ------------------------------------------------ ---------------------------------------- ------------- --------I------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------- ----------- ------- -------------=- ------------------------------------------------------------ --------------------------------------- ------------- ----------------- ---------------------------------- - - ---- ------ ---------------- ------------------------I-----------4----- ----- -- ---- --------------- C........ 0 ------------ FINAL INSPECTION . ........ - --- --- -- --- ----- -- ---- ------- Date--3-------- ---- ------ --------------------- SAN J QUIN L AL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 We Oak Street 124 Sycamore S eet 205 West 91h Street Lodi,California Manteca,C. i. Stockton,California a ornia Tracy,California E5 9 REVI!i90 10-59 3M 3_163 F.P.Co.