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FOR OFFICE USE: ------------------------------------------------ ------ APPLICATION FOR SANITATION PERMIT Permit No. . � •f (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 an Install the work herein described. This application is made in compliant with County Ordinance No. 549. 2-e JOB ADDRESS AND LOCATI � �= f =" "�`�� `'IirA ARD------- JOB Owner's Name-------• --------------- � - ------------------------------- Phone-----------••---------------------- Address-------------------- ---- ---• --------13 .-------311.9_-..._.... ---- ---'----------- --------------------------------•------••------------ Contractor's Name---- ir°lf — -•------------------------------------------------------- -------- -------------------------------------- P.Incine----------------------------------- Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -A__ Number of bedrooms 3---- Number of baths Zt- Lot size -----I-X 0490--- q.--------�---------__ Water Supply: Public system ❑ Community system ❑ Private Depth to Water...Table ft. 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 Lj' New Construction: Yes ❑ No FHA/VA: Yes ❑ No [!r' TYPE OF INSTALLATION AND SPECIFICATIONS:�;�' .. ' � , ic-sewer-js-available within•200 feet.)., 5e tic T nk: P Distance from -Per well-_p�� -�•� - � � � - � -- _� '" No`se t1c��tank or-cess ool"- e�r'rtifted=if ubl __Dista cc from foundation_-_f -__._____.Materia____e��R_�_1______________ No. of compartments- �------ _---------Size ___ 1. __ _ _Li uid de th __ Capacity Disposal Field: Distance from'earest,well..:.`_-_---_____Distance from foundation----!__�----------Dlstance,to nearest lot line_____ Number of•lines____•,_= = -------------Length of each'`line ''. �� r_ . Width of trench--------- �"(_"_______________ Type ofji.Ifer_material�� C� ebepth'of--filter material___- ._ __ '6Total length--------------->/: �---____.____-- Or i r f i ,` Seepage Pit: Distance to near6str4ve11_____.-.__'---_._.___Distance from foundation______________...Distance to nearest lot line________-.- ❑ Number of _ ------------Lining material-----------------------Size: Diameter__=---------------.Depth---------------------------:----- ; Cesspool: Distance; -�,mvearest weII-----------------Distance from foundation_____________ Lining material---------------:____.___________.___. . ❑ Size. Df meter-`-`- 9°>-"• " r Depth Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----.-------- .___________-__________________Distance from nearest building--------------------------------------- a ❑ Distance to nearest lot I'[ne---------------------------------------------- E Remodeling and/or repairing (describe):----------------- -- ------------------------------------- ----------._.-------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------•------ r I hereby certify that I have prepared this application and that the work vtill be done in accordance with San Joaquin County ordinances, ate laws, an rules and re ulafions of the SanJoaquin Local Health District. { (Signed} --- `----- - ------------------- -------- -------- ----- - ------- -------- --------(Owner and/or Contractor} �, "" � By: (T- = ------------ itle) - --.,:�... _ _T (Plot plan, showing size of lot;Olocation of system in relation to wells, buildings, etc., can be placed on reverse side}. ,-----fOR DEPA ENT USE ONLY APPLICATION ACCEPTED BY----._ ,._1 ..Cg= ----------- ------- ---------------------------------------• DATE- I -__;P44r1-'- -------------- REVIEWEDBY-----------IR `. ':--------------- - --------------------------------------------- --------- --------------------- DATE----------------------------------------- BUILDING PERMIT �-- D ATE - _____ ____ _ / ------------- Alterations and/or recommend.ation - -----•---- -----------------------•------------- -------•----------------------------------------------------------•---------------------------------------------------------•------•---------------------------------------- ---------------- ------ ----------•--------------------------- •-------------•--..---- - ----- ----- ------------- - - ------------------------- ------� - -------------------------------------------------------------------------- - ---- -------- ------------- FINAL INSPECTION-Bl':- ----- --- ------ -- Date-_.------ - ------ --------- i SAN JOAQUIN LOCAL HEALTH DISTRICT .rr R. 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktan,California Lodi,California Manteca,California Tracy,California