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FOR,,OF,FICE USE: -------------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ---- ...1_ eF ... -------- - ------- ----------------------- ------- (Complete in Duplicate) SciuT�if -_ , Date Issued _ / _ ---------------- ------------ .---.-,___._.___-__ _.._ _- This Permit Expires 1 Year From Date Issued 'gyp —os 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. m T-c-A �p p JOB ADDRESS-SAND�LZ�CA ON.�_�__��F'------- -- -�_ --��-- ---- ,�=�-�------ -- ------�r=--------��_�'I-�_� ----- - Owner's Name----- 1--- 1c _ ------L-n�_� -- -QN_F)__T)---'=--------------------------------------------- -------------- Phone--------------L----------- --------- Address-- 1,22- -------- Address-- 1 2'1--1---------�� __ -------C- 1------------M-7–c-19----------------------------------------------------------------------------- Contractor's Name---- � ------ ------------------•-------- --------------- -- -------•------------------- ---------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of Diving units:"_`.._.-Number of bedrooms _ Num;? f baths Lot size____.,/ ____ ....tv _________________ Water Supply: "Public. system,❑..,Community.,Sys m f[j-Privateepth--to-Water Table`__ ft. Character ofhsoii to a depth of 3 feet: Sand .'Gravel ❑ Sand-y Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hard an 0 Previous Application Made: (If yes,date._-------__ __.1_1 No E� )Jew Construction: Yes�o E] FHA/VA: Yes NO ❑ TYPE OF INSTALLATION_AND.SPECIFICATION_ S: No se tic tank or cess ool-permitted if public 'sewer is available within 200 feet.) Septic T P Distance from Dearest well-.-S �._Distance from foundation__._/.�� ______.Material----�0_�C�.�T :_____. No. of compartmen#s_.___` _- -__Size___z _.1 �©_ ...Liquid ------ depth.14.................... Capacity___��_�__ i :r Disposal Wield: Distance from nearest well--. __-Distance from foundation._..- ---- ___Distance to nearest lot line�__5______.__ [ Number of lines____-- ��_.___ __ -__�__Length of each line3_0�___.Cx`:__95b---Width of trench-----.��__________.._-_.____ ':r�„ Typeof filter material.___IS / -_-De Depth of filter material_-.-. _ �" � . Yp --- � - p ��: ----..Total length---------/-�-�----'--------------- Seepage Pit: Distance to nearest well-------------t» _Distance from.foundation--------------------Distance to nearest lot line.-.-------------- I y 1 ❑ Number of pits----------------------Lining .material-------s`..............Size: Diameter-----------------------Depth---------------------_-------.--- k l�. ❑Cesspool: - Distance from nearest well------"�'"_""f_Distance from foundation------------------- Lining material------------ _ ___ _________ ___________ Size: Diameter--------------------------- --------._.Depth--------------------- -----------------------Liquid Capacity.-.- -----------------------gals. Privy: Distance from near-est�well _____._„____._.--___ -_ -_Distance from nearest building_-_. [� Distance to nearest lot line--------- ------------------------------------ --- ------------- ----------------------------------------------------------------------- Remodeling and/or repairing (describe)___________________,_ C— l %A ' - 1 --------- i --------='---------- ------------------- -------------------------------------------------------------- ---- I ”' ' F --------------------•----------------------------------------------------------------------------------------- --------------------- I hereby certify that I have this application and that the work will be done; in accordance with San Joaquin County ordinances, State laws, and r es and�regula ions of the San Joaquin Local Health District. (Signed)________!-._ _-_ ___ _.._`��-�_._____._ {Owner and/or- Contractor) _ _:.. - -= w: = {Title) _: _ _ _.... (Piot 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• -. DATE �' C- ------------ REVIEWEDBY------------------------------------------ -- .�_. �. `------------ DATE---------------------------- BUILDINGPERMIT ISSUED----------------------------------------- --------------------------- -------------------- --------- DATE-------------------------------- ........................ Aiterations. and/or recommendations:------_---------------------_____._.. ..........4. " -------------------------------------------------------------------------------------------------------------- -•------------------------------------------------------------------ ---------------------- -------------------------------------•---------------.---_------------------------------------------------- ----------------- --------------------------------------------- -------------------------- --------------•------------------- --------•----- --------------------------------------------------------------------•---------------------------------------•-----------•-•------------------------------------- , FINAL INSPECTIO ''--- --------- ------ -- ' '. . . ,:Date ,!` .............. ----- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT , 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamare Street 205 West 9th Street Stockton,California Lodi, California 4 Manteca, California Tracy,California r r.a.a o.