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rUKUrl- t USt: �- I � - ---------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ?Zt2 --------------- ---------- (Complete in Duplicate) if This Permit Expires 1 Year From Date Issued / Q/Date Issued �'_ __ - r Application is hereby made to the San Joaquin Local Health District for a permit to construct and in4tall rte woAe�n described. This application is made, in compliance wi h County Ordinance No. 549, Z*'T-FROp A, �U JOB ADDRESS AN & CATIOrI - Owner's Name hola ----------------------------------- 'Owner' -- ---- --- -- --- hone` P i Address------ - t it v Contractors Name__-- } g ---•- •.:$ f Phone Installation will serve: Residence ®' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑� I Number of living units __°Number of bedrooms Number of bathsLot size 3 . 3 Water Supply: Public system -❑ Community system 18Private ❑ Depth to Water Table - ft, Character of soil to a depth of 3 feet: *Sand Gravel ❑ Sandy Loam W2061ay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date.......:------------) No 2r'-'-New Construction: Yes RO`No ElFHA/VA: Yes , s 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted tftl ubli* sewer* available wifhin`200 feet.) "" Septic Tank: :X77 Distance from nearest IC -----Distan, fr fau -/ _-- - # Not of compartments.._ �___-_ Siz _Liquid depth- ---------------Capacity- .. Disposal ' - leid: Distance from ne t well - =Distance from'foundati n Istance to nearest lot line-_____ F" Number of lines_._ _ r" L"en th ofa4each llne_ id ;- g , �-« - hof trench '� Type of filtGr—materlad�i De pt}1 of fait r ateGlal_ �" e ---Total length- ---- ------- Seepage Pit: Dist�anceto; earesf wll-__I-.-=_ _____. ___Distance from found'atiDistance to nearest lot P ❑ I� -_-�- � 4 line__�_ �� ____ Number of pts - _---� Lining material----- --------- izeDiameter______---- ----- Depth----- -----__-- -_------___--- Cesspool: Distance fl•om nearest -------------- from foundation---------- material_____________,,F-1 Size: Diameter__---I-------- - -----------De th---------------- -- ---- --- -- - - Liquid Ca P i gales/ 'I f acitY rivy: Distance frog (MiG-tv`jl, i nearest wel!_--__---_---------- -------------_--___" _ Distance from nearest building _____ __ - ❑ Distanced;nearest lot liype __3__ f ! r ` x II 1 - ---- ------------ ------- -- - - - --------- ----- ------- :-Remodeling and/or repalring. (descrlheJ: ."__ . _�________ ______ '� j1t 4� r . f #� ---- ----- -- 4 # 1 ----------------------------- -------- ------ ;--•--------'--•----•------------- -----•----------"zv--'r.:rr---------------------`-------'- ------------ - p� �f I� I hereby certify that have prepared this application and that the work will be done in accordancegwith San Joaquin County ' ordinances, State laws, eLnAxules and regulations of the San Joaquin Local Health District. (Si gned) SEt�`r lC-'-'VgK---SER"CE--- aL _ �y�Rr Contractor) 2915 ner'Ave: „,:;. (Plot plan, showing size of lot, locati� oA of system in relation o wells building ; etc., can beplaced on reverse side. F FOR DEPARTMENT USE ONLY t ih I APPLICATION ACCEPTED BY t ------------------- ---------------------------------------- DATE----- ' d REVIEWEDBY---------------- ---------------:-#----- -------------------------------------------------------------- a - -- ------------------ DATE------------- -------------- ----•------ -----�--•------ + BUILDING PERMIT ISSUED - ------------------------------------------ ------ DATE. # ------------------------- - ------------- Alterations and/or recommendations_________ -----_--------------- ---------- ------------------------------------------------------------„ --- -------------------------------------- ----- - -- ------------------------------------------------------ •------ f =-•----- •----------------------•- - ---------------------------- -------------------------------------------------------------- =---------------- -----•- ------- - --------- --- f' FINAL INSPECTIO ---- ---- ----- Date-------------- 1 _": � 4 SAN. JOAQUIN LOCAL HEALTH DISTRICT ' O1 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street X205 West 91h Street Stockfon,CaliFornia Lodi,California Manteca,California Tracy,California F,P.CO. 1