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FOR OFFICE USE: ----------------------------------- ----------0 APPLICATION FOR SANITATION PERMIT Permit No. ---------- AA- ---------------/ V1 ------- ------- (Complete in Duplicate) Date Issued 4 This Permit Expires,l Year Frorn,Date Issued Application is hereby made to the San Joaquin Loca -------- ----------- I----------------- I 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 LOCATION______---�1717-------....... ---------------------------------------------------------------I Phone_----------------------------------- Owner's Name-.--____-- av__6---------- -------- -----------------I--------------- ------------------------------- ................................................................. ------------ -------I--------------------------- Address _1.7......... 5-az -------------7`1-1--- ------------- Phone.// Contractor's Name------------ ------/y/ -------------------------- ------------------------------------------ ❑ Installation will serve: Residence,K Apartment House 171 Commercial 0 Trailer Court E] Motel [I Other Number of living units: ___f Number of bedrooms ---%7- Number of baths _/__ Lot size ------ ----------------- Water Supply: Public system X Community system [-I Private n Depth to Wafer Table _a6"`ft- o Character of soil to a depth of 3 feet: Sand n Gravel El Sandy Loam F-I Clay Loam 0 Clay [] Adobe Hardpan 0 J w Construction: Yes El No [�( FHA/VA.. Yes E] No Previous Application Made: (ltyes,clate---------------- No Ne' TYPE OF INSTALLATION AND SPECIFICATIONS: I within 200 feet.) (No septic tank or cesspool permitted if public sewer is available Septic Tank: Distance from nearest well_.-_._._..__-._Distance from foundation._..."._."_."_..._Material------------------------------------------------ - No. of compartments---------- -------------.Size------- _Capacity----------------------- ------------------------Liquid depth---------------------- 171on----_--------------Distance to nearest lot line-.._-__--------.-- Disposal Field: Distance from nearest well-_____.-.__.__------------Distance from founclati trench--.-------_---.--------------------- Type of of lines------------------------------------- Length of each line--------------------------.Width of french, ❑ Type of filter material-F_.__.__---------------Depth of filter material-----------------------Total length--------------------------------7__ .-- --v ---- - Seepage Pit: Distance to nearest well---IW_a Distance fro foundation----/lo- -.Distance to nearest lot line - ---- -- Number of pits------- Lining,materiaL-4f --------------- eq� ---J_ �------------ Depth-- 5Z47� _-Size: Diameter N Distance from nearest well_.-----------.--Distance from foundation----- --------__Lining material------------------------------------- \X Cesspool: ------------ ----------Liquid Capacity---------------------------gals. F-1 Size: Diameter--------------------------------------Depth------I----------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building,------- FlDistance.,to nearest lot line----- -- --------------- ----- ----------------------- ----------------- --------------- ------------------ - Remodeling and/or repairing .(describe):_.-_. cm/d----------- ------ '--T ------ ---------------- -- ----------------- I ---------- ---------41:41a---------------- ------------------------------------------------------------------------------------------- -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- -------------------------------------------------------------------------------------------I---------------- ---------------- ----------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancei, State laws, and rules and regulations of +he San Joaquin Local Health District. -------------i----------------- -------------------------(Owner and/or Contractor) -- --------- (Signed)--------------- --------(Title)------------------------ ------------------ -- ------ -------- 0' -------- ---------------------dove",-0�� n;$�--------------------------------------------------------------------- ize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (Plot plan. showing s FO DE A TMENT USE ONLY DATE---------- - ---------- ------------------------ APPLICATION ACCEPTED�BY---------------------- -- - -------- DATE---------------------------------------- REVIEWEDBY-------------------------------------------------------------------------------- ------------------------------------------ DATE---------------------------------- --------------------- BUILDING PERMIT ISSUED------- "__•------------ --- Alter.ations __------ Alf6rations and/or recommendations:---------- -V__ ___�-------------------------------------------------- ------------ ---------------------------- -------------------------------------_ -------------------- --------------------------------------- ---------------------- ------------------------------------ ------ --------- --------------------------------------------------- ------------------------------------------------I-------- --------------------------------------------------- ..__..._.-__..._....__Lt-.. -------- ------------------------ ------------ ---------------- ------------------ ---------------I------- --------------------- ------ ---------- -------------- ----------------------- -----I------- ----------_------------------------------- ----------------------------- ------ -------- ---------------------- ------------------------- -------------------- ------ 7- ------------------- Date----- --------- - FINAL INSPECTION BY: ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.C(3.