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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. , ;�ej._7.*.f ------------------- -- ---------------------------------- (Complete in Duplicate) ............ ThisPermit 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. This application is made in compliance with County Ordinance No. 549. ,e 2 —03,G —�� 2 r L�5 F. AWF_ A JOB ADDRESS AND LOCATIRf�i Owner's Name.---------- r} =------------------------------------------------------------------- -- ------ Phone------------•----------------------- Address--------------- 11 '----BOX-------7- �-----------EsC �+ ---- -------------------- - --------- Contractor's Name----OLAI/v��r-------------------------------------------------------- ---------- ----- hone--------- ------------------------ Installation -- Installatian will serve: Residence [Apartment House ❑ Commercial Trailer tel ❑ Other ❑ Number of living units: _I_-- Number of bedrd _ Number of baths of size _-317—Jk---JY5---------------------------- Water Supply: Public; system ❑ Community system ❑ Private [Depth to Water Table 34 ft. Character of soil to a depth of 3 feet: Sand 1eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-.----_------_.._-.l No Rr" New Construction: Yes N-'No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND-SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well___a5 -----Distance from foundation-10-----------.Materi !-_. B G T__________________ No, of compartments------- --------------Size_Y_x_1P---Y__�____Liquid depth_____ -------Capacity-__ f3C`,) Disposal Field: Distance from nearest well....-----Distance from foundation----fO----------Distance to nearest lot�liine----• " ,t _.__ Number of lines-------�----------------------Length of each line----- S'__#_ h of trench.____,_-_-___--4-._-.-___ Type of filter maferial---R-V-C1------Depth of filter material-----ji----------- Total length---------------- ----/:�;ON Seepage Pit: Distance to nearest well----------------------Disfance from foundation--------------------Distance to nearest lot rJ line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------.------------Depth--------------------------------- � Cesspool: Distance from nearest well-------------____Distance from foundation--------------------Lining material------------------------------------- V ❑ Size: Diameter.-------- -- ----------Depth-----------=---------------------------------------Liquid Capacity----------------------------gals. (71 Privy: Distance from nearest well____________________________mac---------------Distance from nearesf building--------------I--------:L .' ❑ Distance to nearest lot line- ----------------------- -------------------------------------------------------------------------------------------•-------------------- Remod ing and/or repairi (describe):---- _Ai.--`..Pa-5j16ft-------FO R---------�t_oj ----- _> ( ------------- / r - - t� 1?_ 0-<V^-4 ---------------------------------------------------------------------------------- ---•---------------------------------------------------------------•------------------------------- a„�..i -------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--Ci - ----- - ------------------------------------------------------------------------------ -(Owner and/or Contractor) BY ---------------------••------------------- - (Title) (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-------Tt-R..0------------------------------------------------------------------------ DATE----------- _r: l'�.:~� REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------- -----------------------------------------_ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ QATE--------------------------------------------- --------------- Alterations and/or recommendations:------NVTE�...--.5W_09 d_C --------h�---------� ,J�C�-_-----------F�,d-/---------------------- -------------------------------------- ---------- l3- A � Lr*�1 -------------`rw_-D--------- --------- ------t------------- ------------------------------------------------------- ------- - ----------------------------------- ------------------------------------------------------------------------------------------------------------------ - - - ------ --- ---- ---- ----------------------------------------- ---------------------------/-------------------------------- FI N AL --------------------FINAL ! ECTION B Date _+----- 7 ..........- ---------------------- 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.