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APPLICATION FOR SANITATION PERMIT Permit No. .Qzv.`r (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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. �1 JOB ADDRESS AND LOCATION------ ..-�_JJ`L. � rJLQ 67,f1-- ------------....----- ---------------------- Owner's Name---- .Y'T�-` i�l':g-'----"-'---"-�---'----....... _.:........ ...__.._..._. .....------ Phone-jf,55•--Z7.�F.L. Address.......... �/ r--r-i /�- -;1-r1Vl�-------------------------------------------`--- ------------------ pr ` p Contractor's Name..--�<_•�.:.-� .�/SLS/f--�.wrP7?fi-�/?�'------------------------- Phone.--1&4;e` We97 Installation will serve: Resid`enLe��^sApa ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --- — --- Number of livingunits: -1 Number of bedrooms -,7.- Number of baths ----L Lot size [y- Water,Sgpply: •.Public system ❑. ,ClomT 'nity.system ❑ Private Depth to Water Table - g. ft. Chargratet'of soil to a depth of 3 feet Sand ❑ gavel ❑ Sandy Loam Clay Loam ❑ ClaylK.AdoleftEl Hardpan ❑ Previous Application Mader (If yes, \�....... -f. ._I o -New-Construction: Yes ❑ 'No FHA/VA: Yes ❑ No>( TYPE OFINSTALLATION ANDS ECIFICATIONSa C` Z�;,,�'• � /` (No septic tank of.cesspool miffed i c er,is.pvaileb�Q within 200 feet.) 01 Septic Tank: Distance from ne Fest we .--- Distance from foundation..._�0.__.Material_-j�. e --IA2:1F✓ae.7C No. of compartm t .. _. ............Size...,�2�7iQ. e/, .Liquid depth_..._5: -�'___ -Capacity/ exlrz;�/ Disposal Field: Distance fro - eareA we .�(�-r-Distance from fot7rida�nj --�:-� Distance to nearest lot line.�� ... _----. Numbe lines---.----- - --- ------ ---Length of each line-.'.'rn-1:�- _-- Width of trench... _- .��° H r ------- /Type of filter�enal..- - .. ...-Depth of filter material------1.�----.---Total length..._-_,l Q__-_..---.-... Seepage Pit: /' Distancq M nearest well----------------------Distance from foundation----...............-Distance to nearest lot line----------------- F1 Npmber of pits------------------------Lining material-----------------------Size: Diameter--------- -- Qepth.. ___ ..� Cesspool: 'IDisfance from nearest well --_-.Distance from foundation. ......v-- - Lining material, __ ___ _- Sizec Diameter--- .-.....- --..Depth ... . .... .. - - __'_��-�`iLiquid Capacityul Privy: Distance from nearest well _ r g• . . --. .. . .. - Distance from nearest buildm ...__ ..... ❑ Distance to nearest lot line-. _ eJ .. i,. - __- _._ .___ J �1� Remodel�g and/or�Lrepairifg (descri e): Gl�a�7�l yAre ----�zr --Glrr P. ---- - ---- - - --- -------------------- --- --- ------------------- ------ --- ----------------------------- --------------------- I ------------ ----I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law/ss. and rules and regulations of the San Joaquin Local Health District. (Signed).---_.G/!-/ .-.. ... _-!�•r .lr.�7-_.J�. . . -. ..�_ ,Pl..: -�.:_...______.-.._....--.-._ Owner and/or Contractor) a ----- By: ZP - - - -- - .. -(Title) - -- _. . - (Plot plan, showing-11. of lof, to ton of system in relation to wells, buildings, etc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -------- --- --- - ----------------------------------------------f DATE----.,:------------------------ -- ------------- REVIEWED BY - - ' - -' -- - - - - - DATE -- ----------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------.................. _ DATE ---------- -_....._.------------------------------------- Alterations and/or recomihendationsc _ _ _ __ __ .......----._._. ..---. ------------------- .... --... ....- - .--- -------------------------------------------------------- -------------------------------------------------_---------- --------------- ....... -----------------------'- ..---------- _..---- --------------------------------------- ...... -- - - - - -- -- ------------- ------ - -...-- - -- - - ------------- SAN - - �-- FINAL INSPECTION BY:.._..-... ----_:'_------------------ ------------..._. Date_............: _...._ ..- . :. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Nnrelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy,California F.P CC.