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f FOR OFFICE USE: ` --------------------- ------- ----------- - --------- Permit No. .�C-2.'2_7 --------------- ---- APPLICATION FOR SANITATION PERMIT ----- --------------------/�- -�.------------ (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 to construct and install the work here n described. This application is made in complian with County Ordinance No. 549. �A1 ' � -0�-3b P JOB ADDRESS AND LOCATIO --"-------- E- -�-K----- Wmt------------ =------ Owner's Name-----------•-------Be_--�----------• - --------- hone P •-- Address-----_----- ---- P�+ _.__ ... -------------- Phone------- ------------------------ Contractor's Name4�1�}��R�lU11l�-----�7?�V - �-�---------------------------------- -•- • -- Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - ----- Number of bedrooms ------ Number of baths _ Lot size ---r—cR. ----------------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [r}—Clay ❑ Adobe❑ Hardpan kj {.Pry--- -.Previous_Application,Made:. (If yes,date-�-zr_-:---):,-No�<New Construction:-,Yes,❑• No:[E�'_`EHA/VA: Yes ❑�, No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (; (No septic tank or cesspool permitted if public sewer is available within 244 feet.) Septic Tank: Distance from nearest well---------------Distance from foundation-------------------Material-------------..__----.--.---.-----------__-----. rW1 NG— No. of compartments-------- -----------------Size_:-------- = Liquid depth _ Capacity Disposa,�i�eI,d Distance from nearest well-----------------Distance from foundation--_--_-._--------_-Distance to nearest lot line----------------- l �^� Number of lines------------------------------------Length of each line-=-------------=--------- ---.Width of french------------------------------------- t --------- .-- ------ I, Type of filter material---------------- -------Depth of filter material-------------- length___----------_--_-----_---------_------- 4 Seepage Pit: Distance to-nearest well-__ ®.�---_--Distance from foundation --------. ista , to nearest lot ii � 577---, ,, Xx k Depth-----f . ,(pi" Number of pits---- ----------------Lining materiallRaCK-------Size: Diameter-- -__---. -- :: _.. .. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------.----.----__--------- I ❑ Size: Diameter----------------------==--------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-----------------------------.---------- . ❑ Distance to nearest lot line---- ------------------------------- ------------------------------------------------------------------------- ` Remodeling and/or repairing (describe: *9jD017" )UP%[--__TV------- LS i- ------ r5-MMI".---'--------------------------------- i -------------------------------------------------------- --- ---- ------ --------------- - ------------------ ---- ---- ------------ ---------------------- --------------------------- --------------------- ---------------------- ------------------------ Y ---- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County yyr ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Com. ..___Owner.and o�Contractor {Signed}--={�� - � -- - ------- ---------- -�-------------- ---�-L.y-- ----- ---------------- i `--- - By:-------------- -----------• ---------------------------------•-- ------------------------ ----------------------------------------(Title).----- - --- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY --- t-�.-O7 e--------------------------- ------------------------------------- DATE- = -� ' ------------- REVIEWED BY------------------------------------- - ------------- - ---------------------------------------------- DATE----------------------------------------------------------- -- -------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------•-------------------------- ------------. DATE----------------------------------------------------------- Alterations and/or recommendations-------- --- ------' - -----------------•--------------------- ---=------------------- ----------------------------------------------- ------------------- ----------- -------------------- ----------------------------------------------------- ------------------------------------------------------ ---------- ---------------------------------------------------------- ---------------- ------------------- -•---------------------------------------------------------------------- ---------- ---------- ---------------------------------- ----------------------------------- - ----- --- ------------ L ---- --- ------------•---------- ------------------- ---------------- ,. F FINALINSPECTI� �'�`� Date------------- --------------------------------- ------------- - -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Av*, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.a.co. L