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FOR OFFICE USE: ------------- ...... ................................... APPLICATION FOR SANITATION PERMIT Permit No. ------------ - . . . .............. st-- ----- [Complete in Duplicate) - ------------ -- ----------- -------4 Date Issued ------------- ........... . This Permit Expires_I Year From Date Issued pliCartion described. is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein d sc Application is 7here This application is made in compliance with County Ordinance No. 549. %r4*e JOB ADDRESS AND LOCATION.A3,ne Owner's Name-....... --------------------- -------------- •-------- Phone.----. ------------- ------------- Address--------------- - - - - - -r- ........................... 7 .............. P h 0 n 0.;Pljoep.e,&a-7- 7, e------------------------ Contractor's Name.. .......--t---,90AV installation will serve: Residence [ Aparfment House Ej Commercial 0 Trailer Court C1 Motel 0 Other El Number of living units: Number of bedrooms -X Number of baths J... Lot size ....... ------------------ Water Supply: 'Public system 0 Community system 0 Private[Depth to Water Table � ft. Character of soil to a depth of 3 feet.- Sand [] Gravel �ancly Loam E] Clay Loam El .Clay E] Adobe E] Hardpan C] Previous Application Made: (if yes,date................_..l Na I M-"New Construction: Yes a No E) FHA/VA-. Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tonk! i Distance from nearest well.,-,,", Distance4-05from foundation--/.0.. Material.----1/.P-4 1---------------- No. of compartmenfs-----!77!7------------Size.-4 -Ae#..4--------Liquid clepth574' Disposal ie4cl: Distance from nearest well- "Distance from foundation.-A'P---.- Distance to nearest lot line..9 4' -t..........I.......... Number of lines----f --Lergfh of each lineJA'-'4,.X- -----Zo.'-Width of french,P?4.-' ------------------------ Type of filter material�/12 Depth of filter maferiala�---........Total lengfh...401AP*' Seepag4 Pit: Distance to nearest well------------- -------Distance from foundation....................Distance to nearest lot line-.-_--.---....... 01. Number of pits................ Lining material...._...--- - .....Size: Diameter.............. --------Depfh-------------------------- CeS5P00l. Distance fi-orn nearest well-----------------Distance from foundation.--.-----. ----- -Lining material--.------------.---------------.--_-. /'1 ❑ Size: aterial--- ------------------------------ Size: Diameter- ------------ ---------- ----------Dept h-----------------------------------------------Liquid Capacity- --------- ................gals. *rlivy* Distance from nearest Well_ --------- ....... ....67jstance from nearest building----------------- ---------------------- 0 Distance to nearest ]of line--------------------- ------------------------------------------------------------------------------------------------------------ Remode;109 (describe ------------16W------- -------- _p)for repairing (cle ----- - ------- -.S- ----------. - -----x- .............................. 00 ----------------- --------------- ----- ------- --------------I---------------------------------- ------------------------1.... •---•-•---------------------------------------••---------- ----------------------------------------------------------------------------------------------------.......-------------------------------------------------------------------------------------,---------------------------I---------- ------------------------------------------------------------------------------------------------------ ---------------- ice I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County ordinances, State and rules and regulation of an Joaquin Local Health District. --------- -,�r d/or Contractor) (Signed)--------------------�W. Zs//------ ------------------------------ ------------------- I I ............... .............. By (Title)---- (plot plan, showing size of lot, lacecan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------- ----------------------------------------------------------------- DATE------- ------------- --------------- -•---••---•--._.. REVIEWEDBY-------------------------------------------- ------------ --------------- —----------*-------- -!..l------ DATE-- ------------------- BUILDING PERMIT ISSUED------------------------------------------------- .......)--------- -------- ----------------- ---- ------- -------------- Alterations and/or recommendations:------------- ----------------------------- ----------.........----------------•--. --------I---------------- --------------------------- ---------------------------- ---------- ------------------.......Z ----------- ...... ------------------r-.7------............ ------------------- -------- --- -------------------- -(r.,:............ ---------------- ------------- ..........f--'e-?:.,- " �. -------------- ------- ........( ---------------------------------------------------------/" ----------- ........... ---._-.--.-_-.•----.•-__-• ---------------------------------- -------------------- -- ---------------------- -- ---------------------------- ............ .......;----_--.---_-_------•---I. ............... --------- .................................. -------- FINAL INSPECTION BY:— ------ -------4--------------------- Date—.......... - --- -------- --------------•_------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Waselion Ave. 300 West Oak Strout 124 Sycamore Street 205 West 9th Street Stockton,CWHernin Lodi,California Manteca,California Tracy.Call fornia F.P.Ca.