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OR OFFICE USE - ---- ---- --------------------------- j APPLICATION-FOR SANITATION PERMIT, Permit No. A-8............... & - , ,�2�. _5 --- --------------- - -- -------/-O---M"L (Complete in Duplicate) D to Issued <-�-------- -- This Permit Expires 1 Year From Date'lssued' -7 0 --------------------- Application is-hereby made to the Son Joaquin Local Health District for a permit to construct n install,thiawQrk herein qescribed. This application is made in co'm' plia�nc with County 0 dinance No. 549. construct n 0 IN JOB ADDRESS ND OC _L9117.... --- ... J, ----------------------------- Owner's Name- -------------- ------- --------- --- ----:)L sc ---- ---------j----—-A--------------------- --1-- -- ---- ----- ---- ------- -- Address-------- -------------- - - ----- ___ ___r--- ----44 -------_------------- --- ------- ----------------------- ----------------------------------------- -------- Contractor's Name'- X4, !6�__77,_"y"... -k------ ---- - --- -------- Phone_.___ ��. Installation hone,--- Installation will serve: . ResidenceAparmeat House E] Commercial F] Trailer Court ❑ Mote[ 0 Other ❑ Number of living units:!_Number Number of-bedrooms _ff r'Number of t43--- Lot size -- --------------- -- ---- Water Supply: Public.systemi'E] Community system El Private Depth h to Wafer Table t. o'�f Character of soil to a depth 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam E] Clay F] 643-2--1�ardpan C3 Previous Application Made: {If yes,date----------- --------I No E] Now Construction: Yes 0 No K?- HA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No Sep -or cesspool permitted if public sewe'r' is available within 200 feet.) e2�Sis n .... DJ from nearest well_.__-------------Digfance from fou'n'dafion--------------------Material---------------------------------------- --------- IT} i. No. of cotparfments---------- ------------ 'd d th 0---Capacity----------------------- ----------------------I---Liqw eph ------------- - pfoundation.._. V p4al_��Ielcl Distance from nearest Distance from /s?�____'Disfance fro.nearest lot - ----- Number of lines___._ ........... Length of each line--,---,�u--—--------------Width'of French .q--- --------- Type of filter material Depth' of filter material-./f Total length____ --------- -- ------- V S 5'p if: Disfance,t nearest we0/4W Di�tance f om founclafion---- -----!-.Distance tol nearest lot line---- -------- 4,4U-1 . --- ----Lining material.,__," Size: D ia meter-1 bept�__ Number o� pifs___'),e,_ Cesspool: Distance from nearest weN-:----------------Distance from foundation-----------------Y-Lining maferial------------------------------------- • Size: Diameter--------_ . ---------.i__ _.__---.._._De th--------------- ------------ Li --------------------------.-gals. Privy: Distance f rom -nearest well__._--_-----____________ -____________________-'Distance fr"7n nearest building._.__._.__-____________---.------------.-. -Y ❑ -Distance uilding_-------------------------- ------ -- -Distance to nearest lot line------------------- ----------------:-------- ------------------_ J�d 1 ---------- --- ----------------------------------------- Remodeiing and/or repairing I es ------------------------------------------------------------------- ----------------------------------------- ---- ------ --- ---------- ---- --- --------;c------------------------------------------------------ ---- ------------------- €. - --------------- ------- - ------------- ---------- - ---------------------------------- -------------------- ------------------------ ----------------------------------------------------------------------------------------------------- 7 -------- - ---------------------------------------------------- I hereby certify that I ham G prepared this application and that the work will be done in accordance with San Joaquin County Ix ordinances, State laws, and rules and regullatti;onsff the San Joaquin Local Health.District. gned)_(Z:: (Si � ----- ----- --------------- Contractor) F (Title)-------------------- ...... ........._.. --------------- I _ 'A--------- -------------- By:----------------------------------IIS ------------- I ---------------------------------- ------ -4- ,0 ----- ---- (Plot plan, showing size of lot,: ocation of system in relation to wells, Idings, ef,7cn be placed on reverse side). FOR DEPARTMENT USE ONLY X APPLICATION ACCEPTED BY '-- .- ------------------------------------------------------------------------------ DATE_ ----------- --------------- REVIEWED BY-------------------------- I(__ -- -------------------------------------------------------------------------------------------- DATE----------------- BUILDINGPERMIT ISSUED---- -------------------------------------------------------------------- ------------------ DATE--------------------------- - Alteration p/ano/or recomirnend la'fjov's------------------ ------------ - --------- ------------ ------ ---- --- ---- - ------- ---------- --------- ------- - ------ --- ----------------- ----- 6_9 -----'(2n. -----------( ---------- ---- ----- --------------------- --- -Z ----------- ------------ FINAL INSPECTION BY:..... --------- -- --------- - --------- ..... .............. --------------7---- -------- Date------24 . 1A�11 SAN JOA9UIN LOCAL HEALTH DISTRICT 1601 E.Hu'lelton Ave. 3-00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California 7 Manteca,California Tracy,California X, F.P'C 0.