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FOR OFFICE USE.- ---------- -------- -------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- ---------------- ------ -- -------- __ ___ __ ----------------- V2_ ( , -- -------- (complete in Duplicate) Date issued ------- This Permit Expires I Year From Date issued ----------------------------- -------- ------------ Health District for a permit to construct and install the work herein described. Application is hereby made to,the San Joaquin Local H 549 This application is made in compliance with County Ordinaence . 549 0 -------------------------------------------------------- .. ... - -- ------- - --- -- ----- .. --- --------- JOB ADDRESS AND LOCATION_ ------- ------- .1-7 ------------- Address------------ -------- -------- Phone- Owner .Name------------------ ---------------- ----AKK�-�------------------------- - ------------------ 1; A Address-'-------------------------- ------I --—---------------------------- kS-0-Al�_Cl------------------------------I---------------- Phone-%k Contractor's Name_____________ -----House ❑ Commercial E] Trailer Court [I Motel [] Other Installati,on will serve: Residence 0 Apartment r of bas A I ---- Lot size --- --------------------------- Number of living units: Number of bedrooms ---I--- Number baths Depth to Water c7t Community munify system ❑ Private Table 7-2 Water Supply: Public system El m 01 1 f M -1 Clay Loam [I Clay [:1 Adobe Hardpan El Character of soil to a depth 04 3 feet: Sandn Gravel F Sandy Loa' V Nox 1 Preyiou Application Made: (if yes,date-----------:-- ----) No x New Construction: Yes E] No $ FHA/VA: Yes 0 ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation------- -----------Material.--------------- -------------- Size----- --------------------------Liquid depth---- -------- - ----------Capacity----------------r No. of compartments-------------------------- f I nearest welllo_ -Distance from foundafjon._*dVP -----------Distance to nearest lot line---40--------- 4 Dispos9l Field: Distance from n T__`. I Width of trench.._ )--------------------- Number Of lines Length of each line---3.$77 11-------- .1 lines__ aterial .____-____Total length-----3-!�7---- •F-7 7------------ J> Type of filter ma -.---Depth of filter m tr',a�_ __ r g./ X /0 rest lot line__ ------------ __01 fqgndation____,G;Z7-------Distance to nearest 0 00 Seepage Pit: Distance to nearest well-- -------D sta n ce�rprn . ter----S3.........Deptk_,2_S-------------------- 0 6 0_e-6L&-y'ZSize: DiaT4 Number of pits-67PO ).-L'ning material ____-_Lining Lining material------------------------------------- earest well-----------------Distance from foundation___-_- Cesspool; Distance'from n ------r--------------Liquid Capacity_ . --__._----gals. Size: Diameter----------- -------------- -----------Depth---------------------- ----- -- E I �,' I Privy.- Disfance.from nearest well-_-___.- „ ---------_------------ -I-------- ----Distance from nearest building----- ----------------------------------- -------------I---------------------------------------------------------------------- Distance to nearest lot line------ -------- --------------------------------------------- Fill -Remodeling ----a--n--d--/--o--r----r-e--p--a--i-r-i-n--g----I------- --------- ------------------------------ -----------------------------------------11-�-- --- --------------------------------- -- - -------------- ------------ ----------- ---------------------------------------------------------------------------------------------------- - - - ---- ----- -- --- -- --- - --- ------- --------- -------------- ---------------------------------------------------------------------------------- with S an Joaquin County and that tfie work will be done in accordance a 'hereby certify that I v prepared thisplication J I. ar:gula� of the San oaqu Lo Health District. ordinances, State laws, a r sand cal (Owner wner and/or Contractor (Signe d)-------------------------- - ------------------ --- -- --- -- - ----- --- - ------ ----- ------ ------ ------- - ----------- ------------------------------------ By:------------------- ------- rs ste in relation to wells, buildings, etc., can be plac'e/on reverse side). (PlotIan, showing size of ------ p FOR DEPARTMENT USE ONLY - ------- ------ - --------------------- APPLICATION ACCEPTED BY------------- ------- --- -------- ---------- -------------------------------------------- DATE------------- ---------- DATE__...- -- ------------------------------------- --------- ED BY------_---------------------------------- --------------- ------------------------------------------ REVIEW DATE ------ ---y- ------------------------------------------- BUILDING PERMIT ISSUED------------------------------- --- ---------- ----- X11--- 1 W------ ------------- ------------------ ------------------ ----- Alterations ------a----n----d----/--o----r-----r--e----c----o------n----m----e---n----d---a---t--i-c ------ .. ..........I-------- 01 ---------------------- -------------------------- --------------------------------------------------------------------- ------------------------------- ----------- -------------------------------------------------------------------- ---------------------------------------- ---------- ------------------ ---------I----------------------------------------------------------- -----------------------I---------- ----------- ---------------------------------------- ------------------------------ -------------------------- ------ ---------------------------------------------------------- Date---------- --------- ----------- ------------ ---- --- ---------------------- FINAL INSPECTION BY;______.__ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave 300 West Oak Street 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California Lodi,California e5 Stockton,California -Slop F.P.00.