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FPR OFFICE USE: -- - --------------- ---- -- 6 APPLICATION FOk SANITATION PERMIT Permit No. .cr2 ------__.... �/�/� (Complete in Duplicate) Date Issued -V-__ fir_. d.--- 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. w This application is made in compliance with County Ordinance No. 549. ' --•---------------------------•---- JOB ADDRESS AND LOCATION.. __,tetel _ - E______._.__------------------------------ - - - - - ------------ ` Owner's Name- --•---- - ----- '--------------------- --------- ------ Phonew. ------ Address......... (0---- Address---------f��-� - ----• - ---- --- ---- --- ..... --------------- --- -- ---- ------------------------•---�--/----/------r�---------..._.. Contractor's Name`l ------ :-- - -------- * `- -- ----- - . - -- ---"- ------ -------------------- Phone..�^.P(P"'sa+_1� Installation will serve: Residence U?'—Apar ment Hous ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms y Number of baths -1..__ Lot size //�_-__�_.._`...r.....______----------------- Water Supply: Public system 14-01c"ommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No^-FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) kk Distance from nearest well_________________Distance from foundation--------------------Material----------------------_-__---____----_---____. No. of compartments--- ---------1------------Size-------------------------------Liquid depth------------------ -------Capacity----------------------- D -----------------—-- Di osa d: Distance from nearest well-1'�02{Q_Distance from foundation-___1-0._ ___-Distance to nearest of 'ne__. ._.._ .� Number of lines 1 Length of each line---4eQ-----��---.Width of trench--- .' " k} � Type of filter materia. -___Depth of filter material-__--_l_r'___-__--Total length_______________________'��"4�___--___. // - Seepage Pit: Distance to nearest well_--RO- _______Distance from foundation nearest lot lin �.__.____ 0 nn ------- Number of pits---J-------------___Lining mate ria l__LC�t-- Size: Diameter___- .s�_--___-Depth---- f Cesspool: Distance from nearest well____________-__Distance from✓foundation---------.--------..Lining material-----------__--___________________. ❑ Size: Diameter--------------------------------------Depth--------------- ---------------------- ------------ Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ 17-1 Distance to nearest lot line------------------------------- -------------------------------- ----------- - eo Remodeling and/or repairing (describe :------- -------------------------- -----------•----------- --- -----------------------------------------•-----•- •------..--•------------- -0---- 0---------- --------------------------------------------------------------------- ---------- -------- ------ - ----------------- 1 -;----------------------- - ------- ---- --------------------------------------------------------------- -- 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, a0jrules and regulations of the San Joaquin Local Health District. (Signed) vUa _C/i --------------------- Pes, _____ r-Contractor) ------I TANK SERVICE (Title)------------------------------------- - BY: 29a�-E:•ivli�er flHtl.T=3S4I - (Plot plan, showing size of lot, location of system in relation toildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------r-------------------------------------------------------------------------- DATE-------- ---------------- REVIEWEDBY---- ----------------------------------------------------------- ------ ----------------------- ------------------------- DATE--------------- --------- --------------------------------- BUILDINGPERMIT ISSUED----------------------------- ---------------------------------------------------------------------- DATE-_----------------------------------------------------------- AlterAioad and/or rec mmendations: ------------ ------- ------------------ ------------------------ ��.' --------- 1 _fix-- - ' �!'� 2 -- t ----- -----•- -------- ------ - - --- ---�-------- --- '`'l)�----+r�^L� r=>----- -- y"�eti.-------- --- FINALINSPECTION BY:.. -------- ----------- ------ ------ ------------ Date---------4�- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.