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FOR OFFICE USE: , = APPLICATION FOR SANITATION PERMIT 0 Permit No. .G 1 �' -- --_.--_--�-: --- --- (Complete in Duj licate)` � , 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 herein described. This application is made in compliance with Cou t Ordinance No. 549. '1 / e,L JOB ADDRESS AN LOCATION----------------- � ---------------------�--« .........-- L�'elle. _',,/--------------------------------.- Owner's Name ! f�F -�•• voo�vz -- --- Address - Phone ----------- Contractor's Name_/;,e `-`-----•----- ,D-- ---------------------------------------------------------------•---------•-•--••---- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _---___ ber of bedrooms .� Number of baths/------ Lot size _ra -/ __ _ -------_---------..- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date---_.----- --_----) No New Construction: Yes [-INo �HA/VA: Yes [-] NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Tank Distance from nearest well-----------------Distance from foundation_-.-_--__-__.-__----Material_-.____.--_-_-..__-.__.__--_.-._._--_._-----_.-_. / No. of compartments --___.---_-------------Size Liquid depth Capacity Y s� / P q p. P Disposal Fieldy �]: Distance from nearest well--h Distance from foundation--_-_-_ e.`-e.Distance to nearest Io lip? f mber of lines___________________/-.-_--_ Length of each line---------- r__ _-_-_-.Width of trench------ -__ ---------------- Type of filter material____-.!y' .(_-Depth of filter material_-__._fie-----------Total length--- ---------------/------ 4W—F?See pa e Pit. Distance to nearest well well--- "---------Distancem f_undation__-/�-_-_-__..Distance to nearest lot line_ ...-_-.-_._-_._-_- .Number of its--_-_ _ Lining mateaj G -_-Size: Diameter___ De th-� S-___!� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------_-_-__-_-____-. ❑ 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):----__--- -- �l�a/_ --••--••----- ------------------------------------- --------------•--------------------------------------- -------•---------------------•-------------------------------------------•---••------------------------- --------------------------•---•------------------------------- -----------------••--------•------------------------------•-------•--------•----------------------------------------- --------------------•-------•---------------------- --------------------•------------------------- ------------------------- -----------•-----------------------------------------------------------------------------------------------------------------------------------=--•------------------------------------------------ I hereby cer ' that I have epared +his application and that the work will be done in accordance with San Joaquin County ordinances, Sta I sss,, and ru s d regulations of the San Joaquin Local Health District. (Signed)--- ---- -✓---"------- - (Owner and/o Contractor) By: -- - - ---- -- lri+le) - - (Plot plan, showing size of lot, location of 'n io , b ' tc.;can be pla ed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------- -------- ------------------------------------------------------------------ DATE------------ ---------------------- REVIEWEDBY--------------------------------------------- ------ DATE-------------------------------------------------•---------- BUILDING PERMIT ISSUED------------------------ --------------------------------�------------------ -------------- DATE-.----------- --- -- omenAlterations and/qr remdatio -- `IN T1 --....-•-• e, ------- Z - - ------------- -------------- ---------------------------------------------------------------- - -------------------- ---------------------------- -- -------------- ---------------------------------------••-------- - ---- --------------------------------- --------------------------------------------------- --- - -------------- �-� - FINALINSPECTION BY:..--- - --- - --------------------- -------- -------------- Date------- -------------- -- ------ -- ------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.