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FUROFFICE U5t - ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------- --- ----------------- (Complete in Duplicate) /U I '-� -_-_ .-�} _..................-----_--_--___-....___._._-..___.._- This Permit Expires_1_Year From.Date Issued Date Issued .-___f 7. 007—2.SO_(9 �{ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he�Fei descr ed. This application is made in compliance with County Ordinance No. 549. 1 2S22-f IV ' ' / I JOB ADDRESS AND LOCATION__�,—__W,l�.........40AQ-------j...,�1.7_ds.___..To-A....af---C lJtele------ �.- Owner's Name-------- IAFe------ i �LC --f---------------------------------------- ------------------------------ ----- ------ Phone.� �= _ 4- 3A_7------ Address----------- ��--------------------40- I....... ---- 44Y------ Contractor's Name-------------O.-WWeie------------------------------------------------------------------------------------ --------------- Phone----------------------------------- Installation will serve: Residence N Apartment House ❑ Commercial ❑ Towi6 Gesmi2a Motel ❑ Other ❑ Number of living units: --- Number of bedrooms __ZNumber of baths L___ Lot size ------------------.-- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Tablet. 6-0-ST Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam a Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date................ ) No RL New Construction: Yes;K No ❑ FHA/VA: Yes ❑ No JK TYPE OF INSTALLATION AND SPECIFICATIONS: - (No.septic tank or cesspool permitted if public sewer is available within 204 feet.) /� Septic Tank: Distance from nearest well-S-0-47--Distance from foundation--fQ_fI__Mat¢Tial-AvIA), 4410 ------------------- No. of compartments----------a-----------Size--, -X_$ --9__._-.---Liquid depth.-.--f-�2___:-I,'----Capacity/sQq rds. A ' Disposal Field: Distance from nearest well._ _Z Distance from foundation_-_IA-1V�_.Distance to nearest lot line----5_-FT_ Number of lines--+ __.t------- ------Length of each line____�dA.��-------Width of french----G2V___---------._______- N Type of filter material__.,aL/---Depth of filter material--/2?.ii_--------Total f page Pit: Distance to nearest well_-/.7 ...___Distance from foundation_-_-�F9____....Distance to nearest lot li e__9._.__._.___ --- ee {a Number of pits___-�.,..,__-----------Lining material ine...._... .....Size: Diameter. cz�"_//-------Depth__ ---___---_-_____.__ Cesspool: Distance from nearest weI!-----------------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):---&JfR).......SFO. -/-!C---------F-y-s-AF14---------A-2---------//-?.4e•-C- R------------------------- ----------------------------------------------------------------------------------------------------------------- ------------------------------------ -------- -------------I-•-------------------------------------------------------------------------------------------------------------------------------- - ---------- ------------------ I hereby cer ify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a aws, and //rules and regulations of the San Joaquin Local Health District. (Signed) ---------------ll� ----------- -------- --- -------- (Owner and/or Contractor) _. _ B - (Plot Plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY.... --------------------- ----------------- DATE---- - t �ta- ------------------------ REVIEWED BY--------------------------------------------------------------------------------------- --------- ------------------ DATE---------------------------- - ----------------------------------------------- - ------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------- ---------------- ----------------------- --- Alterations and/or recommendations------- ------ - -- ------- ----- - ------------------------------------------------------------------------------------------------•-------------- ------------------ -----------------I--------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------- --------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------•--- ------------------------------------------------------------------------------------ ------------------------------------ ------ --- ---------- ------------------- ----------------------- ----------- -------------- ----- S— � � ' FINAL INSPECTION BY:-- -- --- - = - -- - ----------------- Date------------_-�- - ---_-----�--- - - .-------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT P� r 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 316cklalt California Lodi,California Manteca,California Tracy,California