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FOR OFFICE USE; --------------------------------------------------------- p _____________________________ APPLICATION Fq SANITATION PERMIT Permit No. .- Q---y7 ----------- - - (Complete in Duplicate) ll i Date Issued .__.__.l�/_6_S. v This Permit Expires 7 Year From Date Issued T App{ication-is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. � � %�1 the:, Lsp__� JOB ADDRESS A �LOCATII N__R�.__? Owner s Name- -- -� - .-�-��-- -- - ---- ------- --- -- -- -- ------- -�=_�P- h�o - --�-'--- f �-- Address------------- -------------------- ----•--•--- Contractor's Name- 1 ------ --e. ___ --------------------------------------------- Phone_ _ Installation will serve: Residence E;-'A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms___ Number of b the /26 't size __ 4 „yam-�r------- Water ._____Water Supply: Public system ❑ Community system ❑ Private Depth to Wafter Table ;/At. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2rHardpan ❑ 14 11 c- Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No-[�J�A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: '" t r '`# e, llmlo septic tank or cesspool permitted if public sewer is available within 200 feet.}�,Distance from nearest-well-----------------Distance from foundation-------------------Material_____________._------- __-__-_ No. of com artments______________ Size---------- Liquid depth --Ca Capacity.-. '---------------- osal, ' Distance from`�nearest well.. ..0_�_.._D stance from foundation---1�._____-Distance to nearest lot lin / p q Ps P Y f Number of lines_._ ______ _ Length of each lin e-----10p_-----------Width of trench._qz-� r-_---___--___ De th of filter material--------/__J_F_ ._Total length---.---_---,�Q�-.1----------------- �. 1} "Type of filter material__ _. _ p i Seepage Pit: Distance to neare t well_/Q.(�1_._._._.___Distance(A rom foundatio _ _Q____.__.Distance to nearest lot line...f �... XNumber of pits-_�.._....._._.%---Lining material_ko _-.Size: Diameter._ ��.-._--Depth-.��-`_______________ Cesspool: fj Distance from nearest well-_-------___Distance from foundation--------------------Lining material-_____________________________________� ❑ '.) Size: Diameter."' -----------# Depth Liquid Capacity-- 9als, Q T Privy: Distance from nearest well_ y._.__..._--.__-----------------------------Distance from nearest building_________..__.___--_._________.._..____--- ❑ Distance to nearest lot line-------------------------------------------- ---- Remodeling and/or repairing (describe):-------- --- -------------- -------------- -- -------------------- --- ----- -�-- • -------------------------------------- - i _________________________________________.____-___-___---______-_____________ --__ ------- ___ _ _ _ ______ ________-------._-------------------------------- -------------------------------- .__ 01 -----------—----------y;------ ---------------- -------------------- ----------------------------------- ------ ---------.---------- ---------------------.------------------q ------------------ I --------------— I herebycert- that 1"h a re ared this a lication a hat the w rk w ll be done I ccordance with San Joaquin Count ordinances, S lawsS nd ules an eg lations the S Joa uln Local alt is Sin --------- - BY -------------------- ----------------------------------------------- P -- •--------------------------- --- ./ {Title} = r on roc or (Plot plan, showng,size of lot, location of system in relati wells buildings,buildings, tC. can-be placed on reverse side}. "FOR DEPARTMENT USE ONLY, IN APPLICATION ACCEPTED BY------------------------------------------------- --------------------cww j DATE------ - ---- - ---5---------------------- REVlEWEDBY--------------------------------------------- ------------------------------ _------------------------- - --------------- DATE------------- ------•---- ---------------- BUILDING PERMIT ISSUED------------------------------------------------- ------------------------------------------------ DATE--- --------------------------- ----------------------------- Alterations and/or recommendations------------- ----------------------------------------------------------------------•--------------•------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------------------•--•--•----------------•- ------- ----------------------------- ----------------- -----------------`---------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ----- --- FINAL INSPECTION BY:. . .. - Date ��` --- --- -- -- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CM _ f