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FOR OFFICE USE: _ J --- -----------=--- 3v--- APPLICATION FOR SANITATION PERMIT Permit.No! 2-------- ` ------------- k. - r (C&nplet"e in Duplicate) -. Date Issued --- :y. --_.__ This Permit Expires 1 Year From Date Issued - -- ------------------- -- ----------- rApplication is hereby made to the Sanlioaquin 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 LO ATION �� : ]. �T i-Sr�LI Owner's Name------ /��d� �® ------------------._. Phone------------------------------------ - f-- &'e Address------------------------------ ----------- Q f ' t -------- -------71-111------------------....----...------------------------•-•----------•-•------------------------ f l /sN^ F + Contractor's Name-------------------J Q-7.7_.x_------`- - -------- ----------------------- ------ Phone--------------- ------------------- k Installation wiWserve: Residence P?-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ .Other ❑ Number of living units: _/__- Number of bedrooms tom-_ Number of baths __ _- Lot sizeA(---I--��------------------------------ Water`Supply: Public system Zj"ICommunity�system ElPrivate ElDepth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Ciay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date--- ---__,------..) No ®-- New Construction:iYes ❑ No ga�'FHA/VA: Yes ❑ No �• TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticeTa.j- Distance from nearest well------.__----.-_Distance from foundation___------___________Material------.-_-__-_-_--.___--_.__--_---.-------- 4f No. o Az?qS ilf compartments------- ---------------.Size--------------------------------Liquid depth--------- ------- --------Capacity-------------- �1 , -- . ` r t - t line--`Dis osal Field: Distance nearest well--- —--- -- Dancofeendation--.-__10--/.-...Distncoto nearest lo ---- l I -------------------- eng h l - ` fI-Y if----- TYPe of filter maternal-- of filter material------- 8 ..____Total length________________________ ________ See a olpli Distance to nearest well.-__-______________Distance f m foundation_ _-_--_-___.Distance to nearest lot line..__--..._ -\>{ Number of its___.__ _ '. �.5ize: Diameter-- _ __��.._._.Depth..o7-__---- �C- p ---------- ---Lining material_. .-�- ---- Cesoo Distance from nearest well-----------------Distance from foundation.._..--.-- .Lining material------------------------- ❑ Size:.Diameter------------- ------ -----------Depth-------- ---------------------_- -----------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------T`---:-----------------------Distance from nearest 6uilcling------------------------------- C] Distance to nearest lot line------ -- -------------- f----------------------------------------------------- -------------------------------------------- Remodeling. and/or repairing describe :----------------.------ /v �< ---------_ k-4-+1�- ------ f r -------•-- ..__-----"---------" ------------------------------------------------------------'------- ------------ ------------------ - -----------------------------------------------------------------------------_------------------------------------------------------------------------------------------------------------------------------------------------ �� 11 # l I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 6,Lin ordinances, Sta ws, and rules a gulations of the San Joaquin Local Health District. (Owner ontrac I (Signed)------- ------------- ------------------------------------- /� (Ow and/or C tor) By: Title U W (Plot p[an, showing s' e o o#, location of system in relationtowells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY 0_3_. ---- . ........... ----- DATE. f7 REVIEWEDBY-------------------------------------------------- -------------------------- ------------------------------ ----------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------ - z DATE Alterations and/or recommendations:............... ,,�� --------------------------------------------------------------------------- ----------------- FINAL INSPECTION BY:...------- �� Date.. -� � ` r {SAN JOAQUINLOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 4 124 Sycamore Street 205 West 9th Street Stockton,California " 1 # Lodi,California Manteca,California Tracy,California F.P-CQx w