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f FOR OFFIC LISV. ------ Q ` 04k pp Permit No. ..._._!_.�.�•�U ( " i APPLICATION FOR SANITATION PERMIT - -----------------=- - ----- ------------------ (Complete in Duplicate] Date Issued . �/;..... --�D _---__-'- .--- 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION..13771_--So. Odell St_reet-,-�---StP!Atgn..•_..--•-----------------------------------------•--------- F --------------- Phone-----B ---318- 9------ Owner's Nam -------------------------- •---•-•• I' •hia. & `7 �n CQg14't' Address---------------------•---�---------------- --------- 37.73Q all._Vit.------------- --------------------------------------- ---------- Contractor's Name----''ThE--- I��Y__'_$C__ SGHT---S-•---T-•---SV�L'_.._.-•-----•----•-- ------------- ----- Phone 0 � t}1 Installation will serve: Residence MC Apartment House Commercial E] Trailer Court [IC1Motel ❑ Other 65' X 1. ------------------------------ Number of living units:l_____ Number of bedrooms __2__ Number of baths .__1_ Lot size --------------____..__ Water Supply: Public system ❑ Community system ❑ Private K] Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (if yes,'date-----------,--------) No ❑ New Construction: Yes ❑ No ® PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool`permitted if public sewer is available within 200 feet.) nearest well-_-____.;_______-Distance from foundation______`_..____:--__Material_________________________;_._.____________._____. Septic Tank: Distance from No. of compartments--------------------------Size.---=---- •--------••- ---Liquid depth---------------- ----Capacity----------------- ---- }, Exi ing l - Disposal Field: Distance from nearest well__�O_1-___.__.Distance from foundation...�.�.Ot---.--Distance to nearest lot 1Fte____ t__::.._ Exi$ ing Number of lines -----1---------------------------Length of each line---_-- Q__-:•------------Width of french �-.-------------------- & ADD Type of filter material___S-pte---Rk-Depth of filter material____--18___-___.____Total length-----------6� _______________________ It I Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------.----.Distance to nearest lot line__----------------- ` Number of pitsLining material----------------------.Size: Diameter Depth ❑ ----------------- --- t �. Cesspool: Distance from'nearest well--------------___Distance from foundation--------------------Lining material--------------------------------- a-- s. ❑ Size: Diameter- - ------------ --------------------Depth---------------------------------- ------------- Liquid Capacity g Privy: Distance from nearest well---------------- -----•-------------------------Distance.from nearest building---------------------.-------------------- ❑ Distance to nearest lot line ------------------------ ---------- Remodeling ------------------ - << = Remodeling and/or repairing [descri7e):__.----"-------- ---------------- ------------•--------•--- ------------------- ----------------------------------------------- ----------- � -. -SUPTLEMENT_ARY__DAA_1-NADE- • ------------------ - _02 Y- • Fn-� x� t- � - he --- r I hereby certify that I h e prepared is application and that the wor will be done in accordance with S n Joaquin County u� ordinances, State laws, and ,rules and regulations of the San Joaquin Loca Health District. _ _ � f t (Signed)-----The DAY__&__NIGHT_._Septie_._T_ank---SY4.- -- ----- ---- -- - - (C"�Contraetor) ------ ------ --trifle)--------------------------------------- ----------------------- {Plot plan, showing size of lot, location oBy`�---------�-----------•�•-------�--"---�--•• •- f system m� • " -�relation to 115, buildings, tc., can be placed on reverse side}. a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--. ------ ---- -------------------- ----------- ,. DATE .� _ ------ - --- ---------------- ------------------- ---- -------------------------------- - - REVIEWED BY ---------- DATE BUILDING PERMIT ISSUED--------'-'---------------------------------------------------____---------- --• ------- ----- ---- DATE--------------••------------------------------ Alterations and/or recommend ations:___=---------- -------------- -----------•-----'•'-----'----"'--"'-"'---"'--""--' •-------------------------- - --------------------- ------- -------------------------- i 1 .=---------------------- ---------•-•-------------•-"- ------- --------•-- i ------- ------------------- ----------------- ----•------------ ------ --------- -------------- i ----- ------------------ ------------=-- ----------•------------•-------•---- --- -- --------------------------------- i---------- # • t Date-------------- � �j FINAL INSPECTION BY:.._r----- ------ •-- -��-------------- - - - - -- - -- -------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americnn'Street.�'X1\1 .yam 300 West Oak Street 114 Sycamore Street 105 West 9th Street V�" Lodi,California 1 Manteca,California Tracy,California { Stockton,California, m ti t E9.9 gCV�CEC B•b9 F.P.0 C,2M 6-6C