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FOR OFFIeE USE: f [� -b ----------------- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..l. `1` -------------- ---------------- ----------------------- (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 constructV11 he k erein des! i d. This application is made in compliance with County Ordinance No. 549. p /�0 4w- ,.,) JOB ADDRESS AND L CATIO -- --- 9s on_ -N'7aSr-___ A_�'_ ._Qj - _._ _ /_�(,�Ge. -------- /(� II Owner's Name ��v®6=� I -.:_.__ Phone_��t. �Z.1 . Address7 `f -� 4. ---`----- .7 ----------------------------------------------•--w-----�-`---//---_--------- 4 Contractor's Names. _____- .l _ Phone-f:t........... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------- Number of bedrooms _Number o aths ---/-- Lot sizJ --------------------------------------- Water Supply: Public system E] Community system [IPrivate Depth t _f-- o ter Table _ - ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ be E] Hardpan E]Previous Application Made: (If yes,date_______---------) No � New Construction: Yes E] No FHA/VA: Yes ❑ No Z''"_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub' ;ewer is available within 200 feet.) Septic Ta k- Distance from nearest -el -- ----Distan g from f�pu/n tic&_.l.0___-----Material _47LG�c�C�------ ------- o. of compartments---Y _ ________Size�_. _7.__?4_Wtiquid depth-----4 p y... ,P ! D' osa Distance from near st wel __ ---�f Distan fro found n..__ �____---.Distance to nearest lot linef`_�.. �• Number of lines---- Lengtr*eaci lin �._____ Width of trench �t�' ..__.____.._� -�- Type of filter materia_ p g ` 6 ��!'�1L1 _Depth of filter ma iaL__._,�_��___.__Total length _�_.__.___._.��--?'.____ Seepage Pit: Distance to nearest well.____________-Distance from foundation-------------------.Distance to nearest lot line----------------- ❑ Number of pits___._._____.______Lining material-------------.__.-----Size: Diameter-------_-----------.----Depth_______--.-__-__---._-____.._- Gesspool: Distance from nearest well-----------------Distance from foundation.___...............Lining material._.______.____._.-____----__-._.. ElSize: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------_---------Distance from-nearest building---------------------------------.-___.-. ❑ Distance to nearest lot line-------------------------- ----------------------------------------------------------------------------------------------- ------- -------- Remodeling and/or repairing (describe) - -------------------------- {d ----- - ----- --- -- ----- ---•------------------------------------------------------------------------------ ------- .. - - - - - - - - lam - - - ----------------------------------------------------------------------------------------------------fd rN', ______._ ________ __----- --{--------------•--__-_A-----_---_..____ _ - ! 6 -------- a.� d- �� 1 hereby certify that I have prepared this applicationthatthe work will be done in accordance with San .loaquin�Coun ordinances, to I ws, and rules and regulations of the San Joaquin Local He th District. . (Signe ___ _6._ ._. P , _..__�W>�dfcrContractor) TitleBy:----------------- ----------•-------- ------------------------ - ------ ------ ----- ( )--------------------------------------- ---- - --------- (Plot plan, showing size of lot, locati of system in r ion to wells, buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ,_ '- ---------------- ------------------------------------------- DATE........= ' ' - =-'- ------------ REVIEWEDBY------------------------ -' ------------- ----------------------------------------------------------------- DATE----------------------------------------------------------- j�r1"T G BUILDING PERMIT ISSUED--------- ----------------------------------------e--------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-----------7?glV-4_____T-------.Fft ____ 4i 1?F1T1.4s __-_________-k,'AR1AN' __� -__--.-_---_--..- ---------------------------------- j tk 4-_0----13Z�----.AP L�a��A--------D ------�'--------�?��_�------.. VAI�,F}6'� - ---.�,cj_5_ (J- = 6447. -�c-tvpc_r.�-0r� _.__ ALS c- , TRA_ W� ----�----T -----F c �+ 1 ! Tl , ----------- ` f�'--------------- . 7: - -------------- - - 9 ------------------ -••-- •-------- ---•---------------- 6 1 FINAL INSPECTION- Y_ 1�` lf� / .f�_:� 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