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FOR OFFICE USE: �. -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .5.za..�6..' � ---------------------------------I------- {Complete in Duplicate} Date Issued - __ r�____� --- ______- This Permit Expires t 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. 549.1W3-4-02416-S:-1-1 JOB ADDRESS AND LOCATION__--F_�A/- & f e ' _-_-______ _ Owner's Name-_ ------------------------------- Phone_ ��-�--zd f Address_-. J�! ------------------- Contractor's O r ----------------------------- - ---------_-- Contractor's Name---- �. -' ,-rrS ,Q7 a"f IC ------------------------------Phone... f!--,W0- Installation will serve: Reside Aparf ent House E] Commercial E] Trailer Court L] Mote[s.[] Other ❑ q Number of living units::_.11---Numb of bedrooms _„?,_ Number of baths ____rLo't1size __ 4. _____ _ ______________ Wafer,Supply.:VU61`c\system,,,❑.,,cGom�hurity system ❑ Private K Depth to Wafer Table Character%of so I to a.depth of 3 feet: Sand❑ gavel ❑ Sandy Loam' Clay Loam 0 Clay Adobe,❑ Hardpan ❑ Previous Application Made: ('I yes,d"ate ._._,.. . ..] No VIN 'Constructian: Yes ® No FFtA/VA�Yes ❑ No TYPE OFINSTALLAT,IONfiANDSPECIFICAYlONSi I S�� (No septic tank or cesspool p r�mitted lf�public ower is available: within 200 feet.) Septic Tank: Distance from nearest we � ----_ anon-----le....__. aterial---oowlr- -----je v No. of compartmVnts __ -__4 ------------Size_--1-,9,�Q�1_Liquid dept.--__--V?—_._.._Capacity/ A� Distance from oun Disposal Field: Distance fromne"a�rert " we�l , Q__._Distance from {on�daaon- _._ :_- Distceto nearest lot line_________________ "f'"� Length of each line__ 4rt Number,fi lines______._ De th of filter mater��-_�I.-.__.___.Total hlen th nch-- -- _ t Type of filter material___ p g Seepage Pit: Distance fo nearest well----------------------Distance from foundation------------------- Distance to nearest lot line.._____-_-_-__-._ ❑ Number of pits --------------------Lining material----------- ---------- Size: Diameter--- ------ - --- - Pth--- -- ------- -----------------. : a- . Cesspool: Distance from nearest well-----------------Distance from foundation___ _____.-- Lining material, -_--..._.._._____._-___________.._. El Size: Diameter -- ---.De th------------------------------------------ u;d Cbpaci,t �ygals. ": — VV.,�"`' Distance`f omanearest well. --- -. VV., "� '"".Distance from nearest b`u'dding �., ❑ ri Distance to nearest lot line = �/ -� OP G.e�w.— Remodeling and/or repairing (describe):_..__ fas ' -- - .---7F - 5-�` _.___._ A�/4-� __ /;Pl- _- -- - -f -' •� _tS _-. _r --- -!de�'� •1 '14/ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r{ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Si ned g }---__-,��-- _; -?�� ]--_- � - - - - -----------------{Owner and/or Contractor} 0. By:----------------- Title)--- ...--- ----------.......:------------ }Plot plan, showing si a of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------=----------- ------- ----------------------------------------------- DATE-------------- REVIEWED BY. ,� DATE-----77=/2 -�'--------------------------------------- BUILDINGPERMIT ISSUED--------------------:----------------------- ---- --------------------------- DATE---------------------------------------------------------- -- Alterations and/or recommendations-- ------ --------------------- ------------------------•-------------------------------------1•-------•---------------------------- --------------------------- -------------------------------------- ---------- ------------- ------- - ------ --------- ----------- ----------- --------------------------------------------------- --.-.------------------------------------------------ --------------------------------------------------- --------------------------- ---------------------------------- ------- - ----------------- --- --------•---------- --------------------------------- -------- ------------------------------------------------------------------------------------- FINAL INSPECTION BY:------- -- -- ..... -----------�--------------------- Date-------------- -------------------------------------------------------- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. ,yy