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FOR OFFICE USE: v ----------------------- - -'�j--� -V --------------- ------------------------------------ - - APPLICATION FOR SANITATION PERMIT Permit No.--------- --------.------ (Complete in Duplicate) ---------- --- ------- Date Issued -------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit tconstruct and in II the work herein described. his application is made in co No. 549. �l9C'S pliance with County Ordinance loo ' NO. SOUT1+ AVE 161 73t .yC ,/ B ADDRESS AND LOCATI '77: -eO.17d------,r�f?_?�----.�at_t� ._ .E�`I /`'� ---- cF:----------------------- Owner's Name-- !1 ' �/f1fJ%/j � -r• J9r= Phone' A �tl'� '�. c _V-----------------------•------------------•------------._..._....----- Address ?�`, �/ rn j� I t `1114 _C1 Contractor's Name 77hjQ-----1_-. . ..4--1--i-�lhi----- ------A"1- _a---•----•--------------•--• pp Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __'___- Number of bedrooms Number of baths /_�Lot size --- Q`QB_�-.- ro _________________ Water Supply: Publics stem ❑ Community system erivate ,�/Depth to er Table __.t?-. ft. Y l!� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------.----------) No ❑ New Construction: Yes FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feetj Septic Tank- Distance from nearest w II---�Q_Q'__Distance from foundation-J-0 t---•--.Material-_6101 e --------------------- No. --------- ------ �/ No. of compartments__ Size_ u ------------- *��A- Liquid depth-s3-t�q------------Capacity-1.? t Disposal Field: Distance from nearest well__I _ . r Distance from foundation_ r�.A_"....Distance to nearest lot li �G Number of lines-----__'� ____ ______-.r-� ._._Length of each line ��--__.-.Width of trench____..0__ �!_____________ Type of filter materia -X ---Depth of filter material---�4�?, __--- Total length-----r ------------------- Seepage Pit: Distance to nearest well_._-_.__--._ __Distance from foundation___________________. Distance to nearest lot line____.._.._.___._ ❑ Number of pits------------------ ---Lining material-------------- ---------Size: Diameter------------.._..-----Depth------------------------._____-- �J Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material--------- ❑ Size: Diameter-,,:., -------------- ----- Depth----------------------:---•----- ---------------Liquid Capacity----------------------------- (v Privy: Distance from.nearest well__________________________-__ Distance from nearest building_______._-._-._________._..___--_._-_._. ❑ Distance to nearest lot line------------------ --------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):----..-------'---------------------------- ------------------------------------------------------•------------------------------------------------------- ---------------------------------------------------------------------------=------------;-------------------------------------------------------------------------------- ----------------•---------------------------•---------------------------------------------------------- ------------- ----- ----------- --- ----- - --- ---- I hereby certify that Lhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an es and regulations of the San Joaquin Local Health District. eLJay & ngAt - --------- Contractor) (Signed)---------SEPTIi✓--"'1'.ZCI�--��tV[�E--- ------- ----------------------------------------- BY�----2915 E.MinerAy�.r_�_HO.6-3841 -----(rifle)------------------------------ _ ----------Vowells, - (Plot plan, showing size of lot, location of system in relation buildings etc., can be placed on reverse side). �yFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- .--I---,.R` _ ----------------------------------------------------- DATE----- ------------------- REVIEWEDBY-------------------------------------------------- ------- ------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE..------------------------------------------ -------------- Alterations and/or recommendations----------------------------------------- ---------------------------------------------------------------- --------------------------------------- -1--------------- --------_----------- -----------------------------------------------------------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------------------------- ---------------- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECT BY:. --�-- ----- r�f1�/ Date-------- ----/ - ------------------- 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.CO.