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FOR OFFICE USE: .r APPLICATION FOR SANITATION PERMIT Permit No. _lp�...`? �. -- --- - -in Duplicae)p4J `S ......................._... .______- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliance with County Ordinarice,-No. 549. JOB ADDRESS AND LOCATION----1- 11-x---- '---;-VA�___.AtJ�(S!---------------` Owner's Name ------- -: .......M�-------- DQ_WRL ._.------ ---------- Phone------------------------------------ Address....... --------------•--------------••-•--Address__..------•------.: --------------------------------------------- •--•-------------I ` l� : � ' 4 s � ------------------- e ' Contractor's Name____Q_V_j%fjjF Z._____!_ \, 'ti ---------- ---------------- - -- ------i ----------'=-•------------'------------------- Phone----------------------•---••------• l Installation will serve: Residence [ Apartment Hous,❑ Commercial ,❑ Tr`ailer Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms _�3\Number of baths _'L_—Lot size ___ CFI EAG ---------------_-----------_ Water Supply: Public system ❑ Community system ❑ Privatep'fh to'Water Table Y-0 ft Character of soil to a depth�of 3 feet• Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (U-yes, ) No,2� New Construction: Yes 0 No �HA/VA: Yes ❑ No �J TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesso�o- ! permitted if public sewer is available within 200Jeet.) Septic Tank: Distance from nearest well....______._...._Distance from fou'ndatiLnl--------------------Material ------------------------_--------- ----------- (4�T1 lf&- No. of comparfr ents_.n�.�.,..<..� ,t Size-------------- - quid depth--------- ------- --------Capacity-..-------------------- Disposal Field: Distance from nearest well_._.a57Q____Distance from foundation----/d..........Distance to nearest lot line__S___.._____ T(aCF_r- Number of linen---.----~�':' � •' ��---_---Width of french-------Z�._�---------SSSS-- •< f) r �-__--.::'::_._..._Length of Each Zine-- ___--- -_-- Type or filter material._. p.Cl .___Dopth of filter material____-.______._..Total length___..___.__y.�_____._ _ •------------ Seepage Pit: Distance to nearest well___-_i�-,5-----____Distbnte from foundation-----/0--------Distanc to nearest lot line .___-��----- i Number of its___ ....// Linin material-,RQGI4_ -- Size: Diame_ter.t_1__..K__f� _ ____De th__._. . Cesspool: Distance from nearest well ❑ _.__:_ _--_---I-Distance from foundation- _-_-------_L_*ining material-------------------------- _g- _e-_ls- Size: Diameter- -- --------- ----- -----------------De th---------------------------------------------------Liquid Capacity Privy: .. ' Distance from nearest-well- - :'--• - - -_ — -.- -��-Distance-from-Fnearest building ___ ____________________ s ❑ Distance to nearest lots line ................. vs `� ----•-----------------r-- SSSS-SSSSSSSS----------------------- SSSS - I .SSSS-.---------------------------------------------------, Remod :t g and/or repairing (describe):---'---- ------- - ---- --------•--------.----------------------------------------------- -------- ---------------------------------------- -----------------------------------------••------- ----•---- --------------------------------------------------------------------------- -------------------- -- I• -----------------SSSS-- �- ------ -------------- ----- --- -------- ------------------- ----- -- --•-------'-------------------------------------------------------_--------------------•--------•----•-----•-- ------------------ I herebycertify I have ---re ared!this application and that the.work.will. be...done_in________________________________________ ____i ._._._ y p p pp �accordance with San Joaquin County ordinances, State laws, and rules and r gulations of a an Joaquin Local Health District. (Signed) g $--•--------------------- y �� " J -� SSSS -�L �_..--- SSSS- --- --SSSS-SSSS-- SSSS -------------------Tiile................... and/or Contractor) Si ned ----- ----- f ) (Plot plan, showing size 6f lot, location of system in relation to wells, buildings, etc., can be placed onreverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -_.___________________ --------------------------------------------------- — 1 DATE- ----------------------- � SSSS ' - SSSS-- --- ------------------------- REVIEWEDBY--------------�-----------------------------_- ------------------------------------ -------------------------------------- DATES---- SSSS--'-SSSS--------- BUILDING PERMIT ISSUED---------- ------------------ ------ ------------------------ ------------------------------ DATE--'---------!-- -------------------------------------------- - - --- Alterations and/or recommendations:_-_._.------- ------_ __ --- ----------- --------------- - --SSSS-- ------------- ____________________________________ ________________________________________________________y_____...-_--__._______:_.__________.__....._._..._______-__.-.__._.____...___._._-.__________-.____-________________..____ - ` -` '' 'r -----±'t-r-------------' ' 3` '------ x..._ :____�- ---------------------------SSSS--=----_�-----SSSS-- -- - -- - - SSSS ----------------------------------------------•------SSSS-- SSSS-SSSS-- - --- ----- ---- - - -- - SSSS-- ------------ ---------'------------------------ --------- ----------------------------- FINAL INS r PEC' T bate L� ..---SSSS-- SSSS --- �{✓ T -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press i��