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FOR OFFICE USE: _-___--_.- APPLICATION` FOIA SANITATION PERMIT Permit No. -- - ---- -- ----- 1 -------- ------------ Al (Complete in Duplicate) Data Issued .r `�� ------.------------� / --- ---..._._------------ 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 herein described. This application is made in compliance with County Ordinance No. 549. ale JOBADDRESS AND LOCATION -�--------- -------- ------ ----------------- ---------------- ---------------------------------------------------------------------• 11 Owner's Name- - ------ '�=~-- - -•------T�---- -------------------- --------- Phone-------------------•----•----------- I Address------ 0_0-------- - -----------`' Contractor's Name----- ---`-' 1'-- --—--•-- -� -------..: Phone----------------------------------- ----------------------------------------------- ---------------------------------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l Number of living units: _j..._. Number of bedrooms j---- Number_ of baths A.._-_- Lot size --__. [5__. ------.2--- ----- Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table-r,ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date__...._....- ) No UP"N'ew Construction: Yes FA--<o ❑ FHA/VA: Yes [Ido f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_r_�_____ Dis#ante from foundation�E+_:-..---..-..Metenal:: 7_- No. of compartments -- ---_-_Sie._..__- .,. .-.. ..Liquid rde th_---.�-`------____-Capacity_-- -..tom+ .. . p s�- � q p -- P tY----- Disposal Field: Distance from nearest well__.- .--_---...-Distance from foundation---E'Gti_-t-------Distance to nearest lot line.._......'.... [� Number of lines.-..o2�-----�---�- ----_ _ ___Length of each line__'7S�_._---__---Wid#h of trench--- ; 2--9�....`'...............� Type of filter material._.1 _c>.Ck-.-_.Depth of filter material..._.�__r_ `' Tota! length-------14._.a._�.----______.- Seepag Pit: Distance to nearest well...—-----------Dista ce.frQ,m fou'}�dation° _[>-__....._.Distance to nearest lot line__ -.----_D Number of pits----!.-------- g C-* 3 p Q ..-.--Linin material��f�4 _ _Size: Diameter.... .. ............Depth �------ ----------.Linin material------ -- ---- ----------------------1N Cesspool: � n��s;=��!?'�tan�e from nearest well.................Dis#ante from foundation._. _ g .Ff " p Liquid Capacity-=--------------------------gals.tv • .;.,`.nS¢ei Diameter----------- ----- --- -- ----- - Depth .� *+� � ❑ �°-mak - Privy: `Dis�anee from nearest well------------------ - - -------------- '�,.,..._.D1stance f bm nearest building-------------------------------..------- f ❑ Distance to nearest lot fine--------------------------------------------------------------- ---------------------------------------------- C Remodeling and/or` repairing (describe ----L------------------ ------------------------------------------- ------------------------------- p r - --------------------- ------- --- ----------------------------------- ------------------------------------------------------------------------------------------------------------- I hereby certify that']. have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an gu tions af. a an Joaq n Local Health District. C (Signed)------------------------------------------ -" ---C----------- - ---------------- - -----------------------------------------------------------==-------(Owner and/or Contractor) " - By:------------------------- --------•----- ------= - - -- -----__(Title)--= --------------------------- ----- - (Plot plan., showing size of lot, loion yste in relation to wells, buildings, etc., canrbe placed own reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------- 1 ------------------------------------------- DATE--------- --- REVIEWEDBY------ ------------------------- - ------ --- -------- -------------------------------------- DATE----------------------- - - BUILDING PERMIT ISSUED-------------------- . - r� - ------ DATE. Alterations and/or recommendations:.--- 1tiC�E.C1 --------- �---- ------------------------- ----------------------------------------------------------------------------=•---------------------•---------•------------------•-------------- - a ---------------------------------------------------------------------------------- ------------- --------------------------------- ------------------ ------ -----------•------------------------------------- ----- --------------- ----------- ----- - - ---- ------ -------------------------------- ------------------------ ------------------------ - -------------------------------------------------------------------- ----- ---- ---- ---- --------- ----------------------------------------- ------------------------- — ------------------------------------------------------------------------------------ FINAL INSPECTION BY:--A.I, " - ---- -------- ---------- 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.Cd.