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FOR OFFICE USE; ` 3 _.________________________---_______________________._. APPLICATION FOR SANITATION. PERMIT Permit No. ��. _ ------------------------------------------------- -------- ------------------ (Complete in Duplicate) - 'Date�Issuedr_-= -- ""- - ---.-- � +This Permit Expires 1 Year From Date Issued �µ^ Application is hereby -made.to the.San Joaquin Loca! Health D.istrigf far a permit to construct and install the.��ork,herein described. This a plication is made in compliance with my Ordina e No. 549. JOB ADDRESS AND L ATION_.. L/� f`� !'.,L- .SL�r CQ Owner's Name = t -------- 6- -- E` � t�!!SrP-=------- -------- Phone-5�.��i�`slI Address--------- �. g 7.71.7z_7 I� Contractor's Name /9 = ..P� --------- p S h C ------------- PhoneL.(_[akflo-E7------- Installation will serve: Residence E] Apartment House ❑ Commercial N Trailer Court ElMotel 0 Other E]Number of living units: -------- Number of bedrooms -------- Number of baths Z--_ Lot size _I __X---1.4P____________________________ Water Supply: Public system X Community system ElPrivate E] Depth to Water Table 4 t0 ft. Character of soil to a depth of 3 feet: Sand El-Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay E] Adobe X Hardpan El , Previous Application Made: (if yes,date-----------_. ..._._} No New Construction: Yes No FHA%VA: Yes ❑ Nox ` TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted'-if-pu61ic-sewer=is�availa6i&within 200 feet.) Septic Tank: Distance from nearest twell_ModE1 Distance from f undation �-_...._----Mfate �_ ___ No. of compartmeits____ _ Sze___ ___�- Liquide t ......__fdapacify- DD6f4L " r Disposal Field: Distance from nearest:well_r4j', Distance`f om f oundation___1_�___------.Dista�e to nearest lot line__.Z:�j_-. N Num er of s ypebof filternmateia _Cl_ _Dep-th.,off{l# material g. vtalthof trench.... ¢_�� ._---.------ L la&!� g-Depth!'01 ! fr I length--!--M�`--�S--!---- ---------- --� C!V Seepage Pit: r Disfance to nearest well---/(�Q/V-a-____Distancelrom foundation-__.2.5�-_._.Distan e to nealhest lot line-. £1._`_._ Number: of pits 5fi�l t_,'Linin ,�ra�ate ial _ � .__.Size: Diameter.._ __ ft .t ttc _ _ ptn_ ------------ I �..�..-�= - . r S. De � --- p �v tante f3 orrtp a�est�welL� "_...__Distance from foundation..._-----________-.Lining materia --__---....___.____._____.._-____iLL Cess ool: Q Diameter-------------- - ---------------Depth' --------------------------------------------------Liquid C 10"ctY - --------------------gal h Privy - istance from nearest w.ell _._-4-_— t - -_____________nastanca,�from�near-est building__ �N_._____-________________________ ❑ Distance to nearest lot kne----- ------------------------------------------------------- IM Remodeling an �or repairing (describe)______ _ .N 5 ,�-------pig_ a2 - S1lLjs ____ _______ __ ___ ._;_-_.---.__------ ----_---.__----�- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------- ��----------------------------------- � ------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------I---------- !�------------ ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance withi San Joaquin County �•� ordinances, State s, an ales and regulations of the San Joaquin Local Health District. t I [Signed] T 0 /-V. -------------------- (Owner and/or Contractor �l. SY•----------------------------------��•�G-`-�-�,-------L-�-�--- --- --�-�_ _ - -------(Title)--------- - -- - - --�--- --- �------------ �--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reveistaiside]. I ll .I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATE - 1 l i REVIEWED BY------------------------------------------------------------ ---------------------------------------------------- ------ DATE-------- ---------- BUILDING PERMIT ISSUED--------------------- - , DTE - - t Altera#ions and/or recommendations: ------------ r.�f`----,�---��- -------------------------:------------------------------------ r ------------ II--------------------------------------------------------- ---------- �- p G ------------------------------ --- --�.` `•�---------z-_-" -� ..._ - ...................... ------ --- ----------------- IM FINAL INSPECTION BY:.......... t� Date----------------- -- ----------------------------- - i SAN JOAQUIN LOCAL HEALTH DISTRICT 1b01 E.kasekon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.