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FOR OFFICE USE: ----------------------------------- ..__._-'________________-------------- ---------------- APPLICATION FOR�SANITATION PERMIT ,Permit No. . ------------------------------ ------ ------ ------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Z __ ------------ Application is hereby made to the San Joaquin Local HealfWBistrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinan e No. 549" JOB ADDRESS AND LOCATION_...- �}c� Owner's Name __. .� '.��-�� _. -------------- � ,�-"4.-.!_�� Phone------- ---•-- Address------------------ ly "p A i '� _ ra `T_ J�1 --- - Contractor's Name__ �_ =_�i"�,!�__,��`�� Q,i� �).�--� � -._ Phone-64 T 7 Installation will serve: Residence 77 Number of nrQ—%d�mn,1Z C1?=- ieI ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Iivin units: __ ,�r Numb'er of'bafhs--- --- LCot�size ----------------------------------•------------•----------- Water Supply: Public system 9 Community system E] Private E] Depth tO later Tble -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [-] Sandy Loam E] Cl6, L'm�❑ Clay ❑ Ad ,obeHardpan F1 Previous Application Made: (If yes,date-......... ........I No ❑ New Construction Yes �L� No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: /�j/�, (No septic tank or cesspool permitted if public-sewer-is"available=wifhin�2l. eet:) AVIA k PNo. of com artment�- (- --�- . .:�`�r.- � - , - �-----.Material - ------------------------------------ ------ E] -- � � p s sfance from foundation- ___- _.__.. 51z q. ' Septic Tan Distance from Weare twell-- -- -- -- Die-------------------------------Li u:drdeti__-_._.----__._____---_-.Capacity.----------------_----- Disposal Field: Distance from neare t weld------•�-:-.__Distance from foundation......t. _Distance to nearest lot line_ __:z9........ T� j.4on 'gyp Number of lines-_ ----1----- -- ---------------Length ofteach h e---------�/f_ -----Width oftrench-----.-- �'�---.-------- [,�y See a e PT Distance filter, a estrlwelL: D stanYo_f ffilt 'a! �y __.Total length_---___.__ C�---------------------- Seepage ___________________ y p P / Distance to nearest lot line__ _ __________ P g w � `-,..�' ---- . �rom foundati -----'�-----'`---� �� [ r �Numiaerof'4its.------ 4i,--Linin mat�i4l _ y--De tn-------- ------ p )"-- ' .:.Size. Diameter�_;._ � . p Cesspool: Distance from nearest well• .- _-�.a.__Distanrom found n_............. ...Lining material---.--__...._______.___..---____-_--_ IJDiameter ----- e the --------- --- -------- libc, 'ac , k -----------gals. Privy: Distance from nearest well----------------- -------------------------------Distance from nearessf building.-. ____;_____._-__ --------------------- ❑ Distance to nearest lot line.------ -, - --- = " ttt __ R Remodeling and/or repairing (describe].------ -!-- ltd. _ ____A_-,f --- - - -•- --:- * .. ��__- -- 1 : f_ --------------- ------------------------ ------------------s ------ ----------------------------- ----------•---- ------------------ ----------------------------- ------------------------------- ------------------------------------- ------------------ -------------------------------- �-------f--- ----------------------------------------------- ------------------------- I hereby certify that I have prepared this application and that fhe1wo�k will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District {Signed) �Ie f��" ff �! (Owner and/or Contractor) - ------ -- - -- ----- - ---- Title rr By:----- �'��`A�_ ( )....... Z ----- ---- ------------------------- (Plot plan, showing sixe of lof location of�systern in relation otw.ells,� wild n.gs etccan,be, placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , � -------------------------- DATE REVIEWEDBY--------------------------------------- -- ----- ------- ---------------- ------- ------------------------------------------- DATE------------------------------ BUILDING PERMIT ISSUED------- --------------------------------------------- ---------------------------------------------- DATE------------------------- Alterations and/or recommendations:------------------ ----------------------------------• ----------------------------------------------------------------•-------•---•--------- ---------------- -------------------------------------------•--------------------•----------------------------------•-------------------------------•--------------- -------------------------------- -------- -------------------------------------------------------------------------------- ------------------------- ------------------------ --------- --------- ----------•--- i --------------- ----------------------------------------------------- ------- --------------•---•-------------------------------•-------- ----------- - --- ----------------------------------- FINAL INSPECTION BY:............ -------- Date-- ------ SAN ----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.CC.