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. RAJ FOR OFFICE USE: -------- ------------ rO- - Permit No. .....fir 30 APPLICATION FOR SANITATION PERMIT -- ! [Complete in Duplicate) k --- - -- , f -. Date Issued _05_4A�--'--- --- - --.-.._. 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 insthe work herein described. This,a ication is made in compliance wifh County Ordin rice No. 549. *1 ~y r., JOB ADDRESS AND LOCATION----------- r►1--------------- _A Owner's Name--------------- 4 ------4x)-- 1 -------- -------,--------------- ------ Phone..---•------•---------••------•----- Address---------------------- Q � �Z.� . _------------------------------------------------------------------------------- Contractor's Name ��-u------�, -s? --------------------------- ----- ------------- ------------------------------- ----------- Phone------------------------•--------- Installation will serve: Residence] partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms .0_._ Number of baths�l,�Lot size __ __ -- -- --------- Water -------Water Supply: Public system ❑ Community system ❑ Privateep# to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Q Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-------- -_ _ )-No. uction: Yes-0 No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Gt�4�I V f" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I � r. Septic Tank: Distance from nearest .J,--Distance from foundation_/_L'--- --------Material---ACV -�1.__._ .._ { No. of compartments__--_..__�----_-.--_ --------Liquid depth------ -------------Capacity_./_aL_o --------- t Disposal Id: Distance from nearest well_._.:.___ -Distance from foundation-_ _. .Distance to nearest lot line_________ Number of lines_'_.____`-____------_---____Length of each line---- 4 --.Width of trench--_ .. __� __---_-___..___ Type of filter maferial_.-1_l,�ry.0---...__Depth of filter material-___ length_--aQ --------------------------- _ Seepag if: Distance to nearest well----- _-___Distance ram foundation---1.4__x-------.Disfance'to nearest lot line-15......... Number of pits...... ------ - Lining material--- sr. ........Size: Diameter.' _ _`_ --------Depth__ _ "t --------- Cesspool: Distance from near.est w.ell_________________-Qistance r, 2 fffoundation.----.._-_.___..__Lining material--------------------- -_____. �.f ❑ Size: Diameter--------=----------------�----------Depth------------------ ------TM ----__---- Capacity=---------------- ------gals. Privy: Distance from nearest well------ ------------------------------------------Distance from nearest building------------------------;----------------. f ❑ Distance f-6 nearest lot lin-e-7771 -------------------------------. !� G ---------------- airin Remodeling and/or re Scscre c� -------------------------•----------------------------------------------•-------------------------------------------------- ---- --- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that I have prepared this application and fhaf the work will be done in accordance with San Joaquin County.t ordinances, State laws, and rules and.regulations of the San Joaquin Local Health District. I (Signed) -------------------------------------------- - -------------- (Owner and/or Contractor) i 6 - I u es'�- --------------------- {Title) Y� - (Plot plan, showing size of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �. ° FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- `- L---/- ---------------------------- DATE �� ,. ��--- - -cj-- ---------- t REVIEW ED BY-_ - "' ----------------- ----------------,------------------ DATE BUILDING PERMIT ISSUI D-== =- - "s` y.., „" "`'"" -------------- DAT ------------------------------- -------------- -- I Alterations and/or recommendations:___.__,5__-/ --------I/ -— 1�_x2_ ---- ---------------------------------------------;----------------- --------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ------------------------- ---- ---------------------------------------------------------------------------------------------------------------------- ---------------- ---------------------------------------- - ------------ ----------------------------------------------------- ------------------------------------------- --- ------- ................. -------------- -------------- r FINAL INSPECTION BY-------- ' -' -------------- - -- ------ Date_...• -- ` '' �r'--- ----------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT " y .. 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.