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---------------I--------I-----------I-------------- - /—I--" - ------ ------ ---------------- ----------__•_-----11 APPLICATION FOR SANITATION PERMIT Permit No, -11)L.................. --- ----------------------- --- ---------------- (Complete in.,Duplicate) -3, '3 ------- ---- ----- This Permit Expires I Year From bate.Issued Date Issued -----------41---��/;r Application is hereby madelto the San Joaquin Local Health District for a permit to construct and install the work herein,46scribed. This application is made in compliance with� County Ordinance No. 549. JOB ADDRESS --AND LOCATION_.jp JS/j_ .. ------P/ - - ----- - .. ....M---------- I- - Owners Name__sp, 'e_12 - C --- Z/ ------------------------- ----- ... Phone------- ----------------- Address..___P:�_... --- K -------1-- --------- I . -------- ----------- -- ' - ------------------ ------------------------- Confractor's Name_= e-24V 'A?_� ----------------- --- -- -----------------------M--------------------------M------------------- Phon --- Installafi6n serve: Residence 0 Apartment oL se E] Commercial El Trailer Court ❑ Motel Ll Other Number of living units: 0- Number of bedrooms _6 Number of baths -------- Lot size Water Supply: Public system El Community system 0 PrivateK Depth to Wafer Table ft. Character of soil to a depth:of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam El Clay E] Adobe L] �Harclpan 11� Previous Application Made: if yes,date-------------- No 19 New Con'sfruction. Yes 0 No E] FHA/VA:"Yes [j No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or ce I'ffed i sewer is av"ailab I''Poo Perm, 'f public- le wi4�tn i00'fee+.) Septic Tank: Distance,from nearest well-- 6'. ---Distance from founclation-16--------Material-----eow e14 1. ------------- -------No. of C' mpartments------ -----------Si,e__J_.Y_9_Y_1�. Liquid d '57 1 :CM 90 :1p�h_-____- ----------------Capacity____,9._&-h Disposal Field: Distance;from nearest well._J"P...Distance from foundation----0..........Distance to nearest lot line---S-—------ zJ I Number--:of lines'_,._._�-----------I-------------------Length of each line-------_144------ Width of trench-.'.:----,AZ_ ------------------- ,7t Type of filter rhaferial--- of filter material-------- i : �j ---________._Total length--- ------- Seepage Pit: Distance �to_rnearest,well---------------______Distance from foundation--------------------Distance to nearest lot line__....__________ El Number O'�,,'pits---------------------Lining material-----------------------Size: Diameter----_----- ---Depth------------ ------------ Cesspool; Distance--from nearest well-_-------------Distance from foundation....................Linin g material: •..____...__.._ ------------- IJ Size: Diameter--------------- ----- ----------------Depth------------------------- - ----------------Liquid Capacity---------- ---- -----------gals. Privy- Distance from nearest well____________________________--1 --- ----- _-------Distance from nearest building-- I- ----- ----- 9-- ----- ------------ C1 Disfance'0;jfo nearest lot line- .------- -------------------------------- ---------------- Remodeling and/or repairlijg (describe):----a_/7WVW ----------------------- ------------------ --------------------------M---------------------- -------------------------------------------------------M-------------------------------------------------------------------------------- 7----------------------- -------------------------------------------------- ---------------------------------------------------------------M--------------I----------M-------------I-----------------M-----------------------------M--------- ---------------------------------------------------------------------------M---------------------------------------------------- ----------------------M----------------------M-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I s and regulations of the San Joaquin Local Health District. ordinances, Sfate laws, and iu ---- ---- --------M-M-------- ------------------------------:-------------I-------------------_------(Owner and/or Contractor (Signed)------ --------- ) /. --By: ..... ------------------ ------ o M---- ----- g e relation to (Plot plan, showing size of lo location of system in wells, buildings, etc., can be placed on reverse side}: FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDy____'— 1. ---------- ----------- ------- ----------- --------!-------------------- DATE----- -. .- REVIEWED BY--------------m--------- -------------- -------- ----------- ----------------------_ ------------------ DATE------- ... ...... ................. • BUILDING PERMIT ISSUED -------- ------------------------------ Alterations and/or recommeri-Ltions:-------------- ---------------- ----------------------_-----------------------------------•------------- + -------•----------- -------------------------------------M-----------------------------------__----------- -----------I------------- ----------------------------------M-M----------1-1------------------- ------------------------------------------------------------ --- ----------- ------------- ----------- --------- - ------------------------- ---------------------------- ------------M-----------------------M---------------- ------------ ----- ----- - --- ----- --------- -M---- --- ------------------------ ------- --------M-------- -------------------- - ---------------- ..........M------ .......411----- -- ---- ------------- Dte..... -- ----- -- --------------------- ----- --- --- - --------- FINAL INSPECTI - ------ ----------- .1 ---------:....... ------------ - -------------------- Date-----. - --- - ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F:CLL