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FOR OFFICE USE: /J,7�# -------- APPLICATION --------------- -- _ _______________ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --------------------- This 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 herei described. is applijation is made in compli 1,-,,3'O nce with ty Ordinance No 9 J � l © -Al- SOU714 Ayr—) �� B ADDRESS LOCATION_. s Z17 ---►---E.- .. 00 Owner's Name ___ ----- Phone------------------------------------ Address.............. --- 19--- --- . ....... `'' �l r ._ -- - -------- Contractor's Name.__ 1.11-------- ._ _ �'--:-__ ----_ -__t ,___--a �. Phonef,�l� -r�� + ---- ----------------- Installation will serve: Residence Apartment House jLje.Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .s^ Number of living units: /----- Number of bed ____ room umber of s�1-'Iot size _-_ ------------------- Water Supply: Public system ❑ Community system E] Private Depth to ter Table ___Q_pp_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam e Clay Loam ElC ❑ Adobe❑ Hardpan ❑ Previous-Application Made: (If es,date__-__-_- -) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATI C CATIONS: (No septic tank cess ooi 6ermi f u 'c available within 200 feet.) Septic Ta D' tance�d near w _ . ______-Distanc� fro row, iPr�_..__�D____. ��__I _________________________________,�__,_ No. ments- �----------------Size-j-4--t�-_ Liquid depth -Capacity f Z.---- c z� ` Disposal Field: Distance from nearest well-45V Distance from found n---`Q __Distance to nearest lot line-_____-_�� Number of lines_._��____ ______ _ _ __Length of each line_ @..^_�©Width of trench.. .. �i_��_.__-___-__-_ Type of filter material __-Depth of filter material-_1 ��_________Total length__� t_Q_�___.____._._._________. tN Seepage Pit: Distance to nearest well_________________ ___Distance from foundation....................Distance to nearest lot line--._-_------_-_-- �,, ❑ Number of pits-----._- ---------.---Lining material--------.--------------Size: Diameter.----------- Depth-_.__--_____--__--_----_-__-- Ces pool: - Distance from nearest well-__-_ Distance from_foundation_.—__—__.-.LiAiag-Fn8r8F*1�I___--. ❑ Size: Diameter-------------------- ----------------Depth---------------------------------------------------_Liquid Capacity_-------------------_----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 17-1 Distance to nearest lot line------ --------------------------------------------•------••---------------------------------------------------------------------------- Remodelingand/or repairing (describe):------- ------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------- t ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify thatjl�rrave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an �ules and regulations of the San ;Joaain Local Health District. or Contractor) Si ne ---- - - 9 -------3EPTtC--T.�[V1�--SERVICE--- --------- -- ------ - ---2915 E MtnerAve.r aHQ.6.3841 ----- Title------- ---------------------------«-- ------------BY- -------------------------- -------------- ( )(Plot plan, showing size of lot, location of system in relation t , uildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--------- 1----=-RO`--------------------------------------------------------------- ----- DATE------ `' REVIEWEDBY-------------------------------------------------- --------- ---------------------------------------------------------------- DATE.....------------------------------- ---- BUILDINGPERMIT ISSUED--------------_-- ----------------------------------------------------------------------------------- DATE_---------------------------------------------------------- Alterationsand/or recommendations----------------------------------- ------ --------------------------------------------------------- ......... ------•--•--------------------------- ------------------------------------------------------ FINAL INSPECTI Oate � _ 1�., SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c o.