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FOR-OFFICE USE: l --------------------------------------------------------- --_---------------- -- _____..___ -------- APPLICATION FOR SANITATION PERMIT Permit No. _.4W ----------- -- Complete in Duplicate) Date issued .--.'711�- v This Permit Ez ires-7 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. i This application i ode in compli ce with County Ordinance No. 549. sl ("& h , JOB ADDRESS AND LOCATIO - - f! f - �st I '--"-� ---------•--------•-•------- ... Owner's Name----------- �,� - Phone __. - ------------------- Address T ' C 14 ra_ = -------------- Contractor's Name----80 1 1�C - r� T :5aF_o__C = -- ---------�=��p T = 'Phone------------------------------ ---- r Installation will serve: Residence ElApartrde t House ❑ Commercial ❑ Trailer;Gourt❑ Motel ❑ Other ❑ Number of living units: _ ----- Number of bedrooms _Z_ Number of baths . Lot size __j9L7 --------------------------------------- Water --•----_------_-----.---.Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 3S ft. r Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ t—'N---___- No New Construction; Yes �No ❑ FHA/VA: Yes ❑ No Previous Application Made: (If yes,datef TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No-septic-tank-or-ceApool-permitted-if-pub lic-sewer.is=available-within 2004 : -- Septic Tapk: Distance from'~nearest w eli---- .--Distance from foundation_PU-_---__Material---C -LI��_� 2 No.-of coin artments-_1.____ "Q_�-`.�---_--Li Liquid de th___�� Size-- -_- P / I •--. ' _-------- q P --��-�-------CapacitY -------- --------- Disposal ;f=ield: Distance from nearest well.-, -.-D'istance from foundation--------------------Distance to nearest lot,line-----_----.--._- F 1 J Length of each line V_7 - ` � Width of trench.-. -.. . r # 1a I Type of filter n naterial _�j ---Depth of filter material_._J�_____--_--..Total length--------------- f_ ------------- Seepage _-- ---._Seepage Pit:' Distance to nearest well-----------------------=-D..istance„from,foundation--------------------Distance to nearest lot line_---__----_-_. ❑ Number of pits. _______ Lining material--_------------- -Size Diameter._--- ---. �___---Depth 1 ; Distance fromfoun'da for . Linin Cesspool: Distance fi'omnearest�well--�W ____ __ # ---_- -.-..�-^^. g ;material-- -------- --- -- - ❑ Size: Diamefer- - _}...1- = - Depth -----~ - -= - - -`=----kr i--- Liquid 'Capacity gals. Privy: Distance from nearest-well----- -------------------------------------------Distance from nearest building------------------------------------------ 0" ❑ Distance to nearest lot line-----i-----------_----------------------------°----------_=__---------------------------------------------------------.. ----------- Remodeling and/or repairing (describe)------- -------- -- - --- ------------------------------------------_._..._._.----------------------------------------•---------------------------- --------------------------•---------------------------------------------•-----------------------------------------------------------------•-------------------------------------------------------- ----------------------- ---------------------------------------------------------------------------------------- -------------- -------------------------------------------------- ------------------------------------------------------------- ------------ - -------------------------------------------------------:----------------- ------------------------------------------------------------------------------------ -- I I hereby certify that I have prepared this application and that.•the work will be done in accordance with San Joaquin County ordinances, State law , and rules and.regulatl ns o +he San,laequin Local'HealWDistric+. (�Si-gned)-- --- ---�----� - - { r -------------------.-_.-._. Owner and/or Contractor � BY•------- ------------- ----- ------ _-------- ----- ------ ---�_- --------- -------------.:.- Title ----- _---------- ---•• ------------...-----�------------�� ={(Plot plan, showing size 'of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT-USE ONLY ;J APPLICATION ACCEPTED $Y---- 77 R, 0,----------------------------------- DATE-------------------- REVIEWEDBY------- ------------ ------ '-------------------------- DATE------------------------------------------------ --•--- 9i BUILDING PERMIT ISSUED----------------------------- --------------------------------------------------------- DATE------------------------------=-------------------------- -- Alterations and/orrecommendations-- ---------------- ----- -------------------------------------------------------------------------------------------------------------- : - SGL)<--------ice_ .- - ------=-=--------------- ------------------------------------------------ ---- ---------------------------------------- • -----•---•-- ....--- --------q_� ,�----._._._.---------------------?----_-----'�----------------------.._~------------------------------------------------------------------------------ ----------------------------------..._._....-_.. _...-.-.---------__I--____-_._- •d',f( -----------------•__-------•-•-•--••-----•--•------•--...---....---_•-•-•---•-••--- __•___- FINAL fNSPECTI0'N_B=f �-'��.-- -� /J ��.9r' Date ��__ ------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton, California Lodi,California Manteca,California Tracy,California i F.P.r o. .