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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----- [Complete in Duplicate] �� -� - -� bate Issued ------------------- .-------_--------------.._..-._._.___ j This Permit Expires 1 Year From Date Issued 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 LO 10 _-- _ ------- __ ___f__ Owner s Name-------------- - - -------- ----- - 1 -------- Phor��IP Address------------------------ ---- ----- -- •-•- ------ --------------------------------------------------------------------.... �f ---------------- Contractor's Nam __/V , ) ` ��` --------------------------------- Phone-------•--------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---! __ Nu .ber of bedrooms __umber of baths --/-- Lot size ___ Water Supply: Public system F Community system ❑ Private ❑ Depth to Water Table -------- ft, y 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ fl Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ I� TYPE OF INSTALLATION AND SPECIFICATIONS: I11 (No septic t cesspool permitted if public sewer is available within 200 feet. is Ta k: Distance from nearest well______________Distance from foundation--------------------Material----------------------------_---___----_._..-___. o. of compartments--------------------- -- Size -•---- -----------------Liquidepth------------- 7-C-5—pacify- -----------CaPoutY-- ------------- It �/ osal lel Distance from��nea+re+ st well- gin- ` Distance from foundation--- -0 to nearest lot line______ ________ Number of lirfies„�_,1----- ----------- -----Length of Each line-------------i�-C1__or----Width of french.._!�__x/.�----------------- �- of filter inter a'1= _ Depth of filter material__�.�_;+' ------------Total len th - - - �_-�`__.-__-.-- S a P Distance toane9f` a 1rest well. ._ __ ______Distance from foundation_-Q____._. Distance to nearest lot Number of its4___ ___________ _ �Li�nhg materiaiiGlpb ______.Size: Diamete .......De fh___ ` "-�i Cesspool: Distance from nearesf el!________________IDistanc 44m found'g ion...-_-_.----- "^-Lining materttal--------------------------_-. u ❑ Size: D'iarRNei+ -�©epth _Liquid Capacity ---.gals. � ] Privy: Distance fromnearest well_______________ F ----------------- from nearest building __..__________.______.________..___-_. ❑ R ------- ----- Distancte-L�arest lotjline------- ---�-=---� ---- � -- - �-------------------- -- --- ----- ----- -------- ---- -- Remodeling and/or repairing (describe}: -- ----- ---------------- - - --------------- -------------------------------------•---- - ------------•-----•--------•------------------ ------ ---------' ------..... - - - ------- - •---------------------- --- ------------------------------------ --------- ------------- ------------ 1 -----------------------------------------------------------•}------------- ----- - I hereby certify t I shave�repared fhiswapplication-and,fhat the work will be done in accordance with San Joaquin County ordinances, Sfafe"lawsZ rules and regulations of the San Joa n Local Health District. 'YJts>tit -R- (Signed)--- 1-q K SF_IaVlGF------ ------- ------ ---------- --------- ------ - ---- ---- {Owner and/or Contractor] SEPTfC H0.6-3841 *1 - --- ------ -- ------------------ By:.29.1.5_f__Mine- Ave---- ---------------------- .------- ------------`----- ---- ---- -- -- �.( .._(Title)----------------------------------------- Is ------------------------------- ----- I (Plot plan, showing size of Itt, location of syhem in relation to w Is, buildings, etc.,/can be placed on reverse side). I I FOR-DEPARTMENT,USE=ONLY APPLICATION ACCEPTED BY - -- --------------- ------------------------------------------ DATE-- - _ _'(0 4-----------------------------I REVIEWEDBY------------------------------------------------------------------- ---------------------- ---------- ------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------- ---r----------------------- 4DA-TE------------------------------ ------------------ ------ Alterations and/or recommendations: ------------ ------------------------------ ------- ----------------------------------- ------------------- ---------------- = ---- ---------- ------- - - ------------------------------------------ -------------------------------------------------------------------------•---••.------------- - ------ ----------- ---------=a --•--------- ------------------------------ ------------------------------------ -------------------------------------•----------------------------- --- -------- --------------------- ---- -- -.--------------------- ~--- -----I-------- ------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------- ] --------------- - ---------•------------------ ---------------------------------------- -••-------------------------- - -- --- - ---------------------------- ------- -------------------- FINAL INSPECTION BY:.. .�._.1.�_...�Z ----------------------- Date........ --------------------------------------------- - -- - --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California