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FOR OFFICE USE: ------------------------------------------------------ 9 APPLICATION FOR SANITATION PERMIT Permit No. 1..Z2. --------------------- - - f -------------------- -- (/4 v - (Complete in Duplicate) WDate Issued �! --_.________---____--------------- ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a pe�mit t_�oo co struct and install the work he ein described. This application is made in compliant With County 0 Bina ce No. 549. 4-�T 1247"C-- �er•� JOB ADDRESS AND ,LOCATION-/;'l _ _�� -- ----- ___ ` (- - /,Cj�_ r Owner's Name___ __ _�_ L,. ---------....-__ _.______ . ----- Phone_ _y_- j , A� —'� Contractor's Name- `\ - �` ' �' \ i-._- Phone f = . Installation will serve: Residence [t--A-partment House ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I- Number of bedrooms___-_ Number o a _ _ Lot size --- ......7-15- Water Supply: Public system ❑ Community system ❑ Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Fp (No septic k or cesspool permitted if public sewer is available within 200 feet.) a Distance from nearest well-----------------Distance from foundation___________________Material--_---____ _-___-__---_-____-____.--_____. No. of compartments--------------------------Size-------------------------------Liquid depth-------------- ----------Capacity-_---------------/------ ield: ante from ne {est well- -f_Distance from foundation.._ . -_�_�. '' ryce to nearest lot line:_. (;m_.� Number of lines__-------------________ -____Length of each line___.___ _f�___?iwl th of trenchcr.__ "._.___-._-____._._ � � Type of filter material _ - De th of filter material--____f_ .."--Total len th_-______---__/x_!10�_________.._ Yp P -- 9 Seepage Pit: Distance to nearest well--___-____-.__ ___Distance from foundation____________________Distance to nearest lot line---___-____.._.. ❑ Number of pits._---.---------------Lini material-----------------------Size: Diameter _- ---------Depth----------------- ___._ ___- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ Size: _ _Size: Diameter------------------------------ -------Depth----- -------- -- -- - ------ -----Liquid Capacity ------------------ Privy: - ----Privy: Distance from nearest well________ _________ _________ ___.__--_Distance from nearest building -------------- . . __-_._. y+ ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------•------- ---------- ---------------- 4— A Remodeling and/or repairing (describe):_- --------------. __ ____ _________ __.___.__..__..---------- -- ----------- -----------------•-------------- ------- ----- --- ------- ----- -- -- d '�""_ -------- ------- ---- ----- --------- ------- ----------------------------------------- - -------------------------- -•----•---------- -- ---------- -- - ------- --- I hereby certify thakki�r�have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, eAcrules and regulations of the San Joaquin Local Health District. Vay �� (Signed)------£sE-RTfG- �AP.FK SER\fIGE ------- ------- -- ----------------------------,;t(lwrrser a Contractor) 2915 E.Miner Ave., • HO.6-3841 __-.__--_--Title----------------__ By:------------------------------- ------------------- ---- -- --- ------- ------------------------------------------------------------ --- ----------- (Plot plan, showing size of lot, location of system in relation to IIs, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ---------------------------------------------------- DATE �_'—`----4: r---------------------------------- REVIEWEDBY----------------=-----------------`.---------._.. ..-_._,._.------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSULD---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:_:_.._-___-_.---------------- _ . -------------------------------------------------------------------------------- - ----------------------------------------------------------------{--------------------------------------------------------- ----------------1- ------------------- ------ ------------------------------------------------ -------------------------- ------------ -------------------------------------------__-_ -------------------------------------------------------�----- F e / P FINAL INSPECTION BY:---- =.. " o�:t, ------------------ Date--=--- - ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ali*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.