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FUK /OFFICE USE:/ APPLICATION FOR- SANITATION PERMIT Permit No. ----------------- ------- ------------------------------ (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 OrdinanNo. 549. JOB ADDRESS AND LOCAT ON---- --gJC3---=--- ----------- --------------.` °` Owner's Name------- 1_14 tf4Z. I ea -- 1 �� Q > Address � i /_!L -- ---- - - -- - / Contractor's Name_-_ 0 -- � Installation will serve: Residence ®partment House Commercia ❑ Trailer Co ❑ Motel ❑ Other ❑ Number of living units: __ .____ Nu er of bedrooms ___ _._ umber of baths k�_-_ Lot size -C� __ Water Supply: Public system Community system El Private E] Depth to Water Table_____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe+®--Hardpan ❑ Previous Application Made: (If yes,dote---------------_---) No E] New Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Tarr x Distance from nearest well-----------------Distance from foundation--------------------Material------.----------- -______________----.._._____. No. of compartments---- Size--------------------------------Liquid//depth--------- - --------------Capacity---------- r s®I / Distance from nearest well.0-Q .�Distance from foundation__-!1_._-__-_-.Distance to nearest t G --- Number of lines...... {_�___ ________ Length of each line__.____ Q 1__��--Width of trench_..__.__ �} Type of filtEr material 'Depth of filter mat r�iai___ f Total length____________________ r Seepage Pit: Distance to nearest well ��JK ______D'istarice from f undation_-1_ __-_.___.D'sta ce to nearest lot lin l._�_ _ �r W [�� Number of pits-----�---------------Lining material_-�,o.. .- ---...Size: Diameter_ /Depth_ ---------------- Cesspool: Distance from nearest well-------------- Distance from oundation--------------------Lining materi�al__._____---_---------_.._______.___., F1Size: Diameter--------------- ----- ---------------—De11pth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest.well.___t________________3--------------------------Distance from nearest building.-._______-- -----------_-______._.__a__. Distance to nearest .lot line -- ----- ------- ------------ ---------- ❑ ...-------M=- ----- -- Remodeling and/or repairing (describe : - _-=--,------------------?-----------_--- ------------------------------ -------- ------ ------------- - --- --- - ------ ---------------------------------- -----------------------•--- } -- ----- --- ;.,....l- - - ------ - - -- I hereby certify that ave prepared this application and }hat the ori will be dans in accordance with San Joaquin County ordinances, State laws, mules and regulations of the San J uin Local Health District. (Signed)------- - - -- - -J - --------- ontractort �1~PTfC--TA{V}'C__1 E5 2 --------- - ! gy; 29]5 E_Miner Ave:, HO.6-3841 {Title)---------------------- ------- - -- - ----------------- ------ - ------------- (Plot plan, showing size of lot, location of system-in ielation to a s, buil Ings, et can be placed on reverse side). FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY ---- ---------------------------- - DATE-----/ e `r REVIEWED BY ---------------- --------------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------—----------- -------------------------- DATE----------------------------------- Alterations and/or recpmmendations:.._____. _ _ G'�--- - f_ -------- ------------ ._____-------------� � - �'� ` - '��r� ---------------------------------------------------------------- -------------------------------------------------------- -- ------ -------------------------------------- ------------ ------------------------------------------------•------------------------------------- ------- FINAL INSPECTION BY:. ------r0ak ir Date. ------' ---------------------------- SAUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 Weet 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California