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i rUk UFFlCE,USE: e ---------- ---------- ------------ --------- -------- APPLICATION FOR SANITATION PERMIT Permit No. C�o`t � ------------ ----------------- -------------------------- (Complete in Duplicate) ----- --- --------------- This Permit Ex ires 1 Year From Date Issued Date Issued 7ZIV 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. Y 1.4.111 JOB ADDRESS_AND LOCATION------ 2—q-2- ------- �Z ------ _ - -- Owner's Name_� N _9 � - E � �{ jg--LlL AddressIZof ----- ------------------Phone---.!------------------------------ -- - 2 --•---.R_ _ �Q_ --------------------------- I------------------------------ Y- ,% I Contractor's Name 14 R/._ ---------------•----------------------- --- ------ �T"! ----------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [I Motel C-] Other ❑ Number of living units: I------ Number of bedrooms 3 Number of baths --- Lot size Water Supply: ;Public system ❑ Community system ❑ Private 0'�Depth to Water Table /_e-9 ft. Character of soil to a depth of 3 feet: Sand 2!�Gravel ❑Sa100 ndy Loam ❑ Clay Loam ❑ Clay ❑: Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date-------------- __j No [ New Construction: Yes [A---No ❑ FHA/VA: Yes ❑ No ©� TYPE OF INSTALLATION AND SPECIFICATIONS (No septic fank.or egsspool permitted if public sewer is available within 200 feet.) Se tic Tank: _ _ - -- - . - p DiAtancZW nearest well________________Distance from foundation__- ____--___Material_.---`_......_..._..__-_-_--_____ t �Osr�sJGf No. of compartments------ ------------------Size------------- ,' _Capacity----------------------- R --- - - - -----Liquid depth--------- -----�--- - Disposal Field: ° Distance-from nearest well-------------- Distance from foundation--------------------Distance to nearest lot line_-___----__-_._- p C t f MCT Number of lines-----------------------------------Length of each line------------------------------Width of trench---I------------------------- 'V Type of filter material------___,.R-------------Depth of filter material.--_--_____---____—Total length----------I Seepage Pit: Distance to nearest well-_'40_ from foundation---JD ----------. istance totnearest lot I� Number of pits------J-------------(Lining material._R00------.Size: Diameter__ Xz-57_7>.Depth_T -6r- ---- t Cesspool: Distance from n arest�well _._Distance from foundation------------- --- - Z"r r Lining material ---------------------------- ❑ Size: Diameter #---�- Depth----------------------------------------------------Liquid Capacity- A- Privy: Distance from nearest well-----------------------------------_--- --Distance from nearest buildingF ❑ Distance to nearest lot line_!____________________ j # ------------------------------ Remodeling and/or repairing (describe):----__--__FEBMl']--_-----/ lM_- -_-__-0__k_T �g �jti P= _t/m � ©r I -----------••-------------=------------------------ ---------1057-0 ATi C� -------------------------------------------------- ----- ---------------------------- ----------------------------------------------------- - R-a --- ---------------------------- } -------------------- ------------------------------ --------------- ---------------------------- ----•--------------------------------------------------------------- ----------------------------I hereby certify that I have prepared this application and fhat,the work will,be done in accordance with San Joaquin County ordinances, State law and rules anA regulations of the SaA"Jloa_�uiri Local!Health District. (Signed)-,---------- --------- -' --- - r ---------------------------------------------------------------------- - ---------------- .----- .(Ow By. � � _(Owner r Contract ---- - L '------------------ -------(Title)--- ---------- ----- o ora (Plot plan, showing.size of lot,_Iocation_o _ ystem in relation to wells, buildings, etc., can be placed on reverse side-- }FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY x} '---I-------- ------------------------------------------------------- DATE_----- REVIEWED BY------------- } ------- - ------ DATE- - - ------------ --------------- --------------- --------------•- BUILDING PERMIT ISSUED-------I--------------------------------- ------------- DATE Alterations and/or recammendations:____. ---------------_---- ------------------------ --------- _ ------------------_.- -._:- _ - --- --------------- ------------------------- -—-—------------------------------ -------------------------- - ------"--N --"vv---,---l------- � ----------- FINAL INSPEC Date-------- - ---------- C1. 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 F.P.co.