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FOR OFFICE USE: =Gt. APPLICATION FOR SANITATION PERMIT Permit ��o. - --------------------------- -- ------------------ - -------------------------I- --- --------------------- (Complete in Duplicate) _____________ _ ____ This Permit Expires 1 Year From Date Issued Date Issued -2, 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. JOB ADDRESS AND LOCATION 11 IY h1 lvQ �' ----------------- /30--f?------- Owner's Name..... -------.4FIWJllr-llf,�741�----------------------- ------v------ Phone----e7'.3_Q?31.. Address-------2 .16—..----- ./.....n�/9-i5v------�--------------lmez te!Gln---------exml, LT-------------------------------------------------. Contractor's Name------------- Fr._�9'Ll-----------• ------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence 10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms_._ Number of baths _ '._ Lot size -------- ------------------ Water SuPPl • Public system CR system El Private ❑ Depth to Water Tableo__ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ , �` Previous Application Made: (If yes,date___---------------__) No ;R New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No's Ir TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----J__10.__----Distance from foundation__.__1_0-------Material-_. --------------------------------------------- 56 No. ________________ ____________.______..____- No. of compartments...___..__"_�- -__Size--------`7�47PO----- depth------ -------..._._____.Ca Capacity----- -- Disposal `-�--'-`'- Field: Distance from nearest well...�d.__._Distance from foundation_____-_•_________._.Distance to nearest lot line------------- tZ Number of lines___._ ....____ ___---- Length of each line__..____--s�________._.Widtl} of trench"____________ ____________________. Type of filter material-_---I l6.C!s-...___Depth of filter material----------------------_Total length_______ -___________._--._ Y Seepage Pit: Distance to nearest weld---J0Q----------Distance from fRunclation____. b______-_.Distance to nearest lot line_.__------ - __.._ -_ "._.Size: Diameter._. ----Depth_-_./0 #-_-----__-__Number of pits---_----s ----------Lining material_ ,t Cesspool: Distance from nearest well-----------------Distance from foundation."_-----------------Lining material__._.._____.-_ -'____..________. ❑ Size: Diameter----- -------------------- Depth------------------ ---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we€L_______________---_-----------------------------Distance from nearest building.____.____.__.._---___- Distanceto nearest lot line------ ------- ---------- --- ------------------------------------- --- - ------------------------------------------------------------ j Remodelingand/or repairing (describe):---------------- = --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------- ---------------------------------------------_- --------------------------------------------------------------------------•----------------- ----------------------------------------------:------------------------------------------------------------------------ a ---------------------------------------------------•------------------------------------------------------------------------------------------------- --------- --- --- I 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)-------- - --+--- ---*------ ��--- C ,6---------------- ------ --------- -------------------------------- - -------- -- -----(Owner and/or Contractor) By:-----------------------------------------------------------------------r ---------------- (Title) , Title---------- -- ---- ------------ - ----- �. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). h FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED BY------------ ---- - ------------------------------ ---------------------------------------- DATE------...1-7�,7 G.6------------------- 5 REVIEWED BY-_.- - -_--- ---------------------------- DATE_ BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------- - ---------------- DATE----------------- -------------------------------- Alterations and/or recommendations:--------- ------------------------------ --------- -----••-- ---------- �KTQ Jar y ;` ------ ' -S1.- � 0-e---Ccs - - - I---/j/_ J=tea/ — -- ----------------------- ------------- ----- - --------- Er�j ' H iL- k i d --°--------- Ze T' FINAL INSPECTION BY:- ................. D -:__ - ------------------------ -- r /fL`f CAG-GAu�Y!(1 �10�4�.Cty �Tpu�C � �/ rILC J SAN JOAQUIN LOCAL HE 5� 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi California Manteca,California Trac California Stockton,California � Y, F.RC(3.