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ruK - - i __-------------------- ----------------._----__.-------- APPLICATION FOR SANITATION PERMIT Permit No. .�� l ---- -------------------- --------------- --------------- (Complete in Duplicate) --- ----- This Permit Expires 1 Year From Date Issued Date Issued E 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. / TCF) JOB ADDRESS AND LOCATION----tp.t27!!LA_N ---- 1f_ -_--- --��-- YomTTA 6-E;�------R b . Owner's Name-----------------------1- --R`[`i _ ---------------•--- - ----'-- --------------------- -------------- - - ------ Phone---------------------------------- Address----------- - - - -- ---------------------- Contractor's Name_CA44-F__..__?R_P-2�e9.577._N-(, ------- Phone-`----•--------•-------- -----------------•-------- ----- ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms _3 Number of baths _/___ Lot size ___ t �� ---------•--------•-- L Water Supply: Public system E] Community system ❑ Private �epth to Water Table - - ft. Character of soil to a depth of 3 feet: Sand vel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No,©�New Construction: Yes No ❑ FHA/VA: Yes Er-__'No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: r - No Se tic +ank ar'cess odh ermitted-if`ublic sewer R av iiiable wiffiin 200 feet.) Septic >1k Distance from nearest weli__5Q___:.__Distan e from foundation_ _ _ 7`E _ _ �-------------Mater�aIC01UCRE _ 1/1 IT No. of compartments_..___ ----- -...Size-- -�(-- - - ---Liquid depth---- - -Capacity---- - Disposai >d: Distance from nearest well_-_..5_0 __Distance from foundation._.__++ ---_--_-.Distance to nearest lot line--- ...... Number of lines-_�___-___2-- __Length of each line_____-5 - 'Z �r 7-5___.Width of trench.--------- Type of filter material---RVY&____Depth of filter material___-._f _-_''-___Total length--------------- ----------- i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.--.____..___.. k ❑ Number of pits--- ------------------Lining material----_----.------------Size: Diameter------------ ------Depth-.--------------------- - ---------- Cesspoof: Distance from nearest well-----------------Distance from foundation-.------------------Lining material___.--__----_---______---_ - ❑ Size: Diameter----)----------------------- ------Depth-------------- -----------------------------------LiCapacity---.uid q ------------------------gals. Privy: Distance from nearest well----------------------------------------------- -Distance from nearest buifdin cJ if ❑ Distance to nearest lot line------------------------------------------- -- ------------ --------------------------------------- Remodeling ------------ ---- ---Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------- q I " 1 -------------------------- ------ 'C --------------------------•-----------------------------------------------------------------------------•------ ? r -------------------------- ------------ - - ---------------------------------------------------_-------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St andd regula io of th an Jo Local Health District. (Signed) - - ----- --------------------------------------------------------(Owner and/or Contractor) !"lr --�� .;��...�.• � ._ _ � �.'Title=`". . . !�; -------- -------------- -- -------------------------------------------------------- ( ) ---- ... (Plot plan, showing size of lot, location of system n relation to wells,buildings, etc., can be placed on'reverse,side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -_- _.R_._O_'-------------------------- -- ----._ DATE---------,, --_2 _-..�4 REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------•------ ------ DATE._ - ---------------------------------- Alterations and/or recommendations:. = x ----------•------- -------- -------------- ------------------------------------------ ----•------------------------------ -----•- --- ------------•---- ---- } J` , FINAL INSPECTI" BY -- -., �_-- --.-.�� •='` D F _# T1. ateT SAN JOAQUIN LO CAL 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.RCa.