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FOR OFFICE USE: ss�� APPLICATION FOR SANITATION PERMIT Permit No. ---------------------- ---------------- ---------- (Complete in Duplicate) # Date Issued ------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a instal thew k her i described, This application is made in:compliance with County Ordinance No. 549. � Ltzc!(s► JOB ADDRESt AND LOCATION.-_ �� -"(--Q--�-�-- •--------- - -,�._G- - -- ---.. . ----- ----f--------- ------ Owner's Name-----4A1�}--• ---W p a-011xL.1------------------------------- - -----------------------------------------._. ---- -------------------- --•------------------------------------------------..-.._..------------ �-` � ` Contractor's Nam .LK* Phone---------- -------•---------------- Installation will serve: Residence[Apartment House ❑ ommercial ❑ oiler Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms_._ Number of hs __�._ Lot size _ --------- Water Supply: Public sysfem ❑ Community system E]—Private Depth to r Table _--___- ft. �.-*. 1 Character of soil to a depth of,3 feet:�Saritli❑ Gravel ❑ ,Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made-.-(If y s,date------------ ------} fNo E] New Construction: Yes ❑ -No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.)., r le— f. �� tic Distance from nearest well-----------------Distance from foundation--------------------Material_._."-..--------.-.---_----------__-.."._.--___-- +"� No. of compartments--------------------------Size ---Liquid depth-----------_--- .---Capacity-------- ------------ s F' Distance from nearest well- Distarfc from foundation--- _."_ .Distance to nearest lot line---/1011_. 1 Number of lines----_-I_-- - --- j_-__ Dei-s�thof each line--- � - - --� .---V1�idth of trsch- �f--------------� E, Type or filter material_ _-Depth oflfiltermatenal....._"�_C�- g Tofal len th-------------------------- _c -- Seepage Pit: Distance to-near-estrwell__ 1_Distance from foundation--------------------Distance to nearest lot line___--_--_-.--._.-" Ej Number of pits----------------------Lining material----------------- ----.Size: Diameter------------------.----Depth---------------------.-------.--- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__._____.__.___.____._.._"."._"_""_.-�`�[� ❑ Size: Diameter----------- ------ -------------------Depth--------------------------------- ------------------Liquid Capacity- - --------------------- --gaIS 1 • . , ".Distance from nearest building t• Privy: Distance from nearest well-----• --------------�--�"�-r---�'�'° ------- --g--------------_"-.---- --------------�- r� ❑ Distance to nearest lot lire_............._.__`� ` _ " Remodeling and/or repairing (describe}--------------------- �----- - ------ •t------ �" -------- ------------------------- --------• �-------------------------- ------------------------------------------------------------------------------------- -- -- - - --------------- -=�--- ---------------� ----------------------------- ------------ -- - ------- ----"- ------ --- - -------- -- ---- + _ ________ __ Or ______---_______________________""--.___-----_-----__-----_____".".".___.____.".__-_-_._-__-_----_---__"-__ .._------."-".-.__"------__-...-...______. .. I heheby certify t ) have prepared this application and that the.work will.-be.done i accordance with San Joaquin County ordinances, State laws> �rules and regulations of the San Joaquin Lacel Health District. �a li�� - --- -- ----- ----- --- .. Contractor (Signed) - ..STEf'TtG TP,1�iK SEI�VTGE- ,ByQ9j5_E._Miaer_Av_Q......H�=6.3841----------------------------------- - --------------------------- (Title)---------- ----------------------------------..--.----..------.--- (PlotiplA, showing size of lot, location of system in relation f wells, buildings, c., can be placed on reverse side). © FOR DEPARTMENT USE ONLY APP_JL�CATI REVI,aED BY ACCEPTED BY---- . - ------------------------------------------------ DATE---- --- ........................ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- ---------- DATE------------------------------------------------------- Alteratioitsand/or recommendations---------------------------------------------- -------------------------- ----------------------•-•-----------"---------•--------------------------------------- --------------:---•------------------------ -------- ---------- -------- - - -----------------------•-----------------------------------------------•------------------------------------------------------------------•--- ---------------------------------------------------------------------------------------- ------------I----------------•------------------------•--------------------------------------------------------------------------- � f FINAL INSPECTION BY- - -'.--- -- ___--- Date.- ~/ e -- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxslton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.C9.