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FOR OFFICE US Q ""--""" --------- ----- ---- - ----------- -- APPLICATION FOR SANITATION PERMIT Permit No. - -------------------------------------------------------- ------------- ----_---- -- {Complete in Duplicate{ Date Issued - This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District"fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54.9. y Ai _ ? r JOB ADDRESS AND LOCATIO �_P ------ - ,--------- -1• � ` --- rhe-.�------ Owner's Name----------------------- J '_ _r�,� d----- ------------- Address --- ----------- Phone-------------------` ------ .- .7 --------CJI-----------F5c:g_�Q -------------------------------------- -------------------- f ---------- - •--- - -.. .__ ----- -- ------ -------------------- Phone-------------------------•--------- Contrac#or s Name___ "- - - Installation will serve: Residence RKApartment House ❑ Commercial ❑ Trailer Court ❑ Ma#el ❑ Other ❑ {� f i --- Number of bedrooms _3_- Number of aths __!-.._ Lot size -- i- Qd--- L�------------------------- Number of living units: __� ' Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __.._ __ ft. x 7.j Character of soil to a depth of 3 feet: Sand [Gravel Sandy Loam [I Clay Loam ElClay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------......._.--) No New Construction: Yes �No ❑ FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic >1 Distance from nearest well_____-_"_Distant from foundation____._��___._-Material_..cozq<,L��T� ------ No. of comparfiments------------------------._Size-- Xlt __X-- --Liquid depth--- ,1-y--------Capacity--- f?-Q---- f Disposal Field: Distance from nearest well--_5P-�--.Distance,from foundation___/®-________.Distance to nearest lot line____ -f ' Number of lines_________��..____-_-.-------Length of each line__&V".4'-- -�------Width of trent}:_______ , Type of filter material-------------------- p "Total length _ ----" .-------- rf -._._De Depth of filter matenaL_______________. -- g - - Seepage Pit: Distance to nearest well----------------------Distance,from foundation__--_________..___.Distance to nearest lot line---__._-_.._ ❑ Number of pits ` Lining material------ Size: Diameter----------------- ---Dept'n------------------------------- Cesspool: Distance from nearest well,'--------_------Distance from foundation--------------.-----Lining material------------------------------ __ls.__. ❑ Size: Diameter : ----------Depth------>------------------------- --Liquid Capacity-_------------------------ ga---------------- ► { . Distance from nearest building------------------------------------------ Privy: Distance from nearest well:__-.__----------------_-__-__- _ - _--____.__ _ 1 ❑ Distance to nearest lot line----------- ---------------------------- ------------------------------------------------=--- "== C�7c15~i Remodeling and/or repairing (describe):-------5E�L „_--_--�.� ��_ ..=__T --_------• - ��"� -----150!t� RV 1 1 N '� fl F VSE r i Sfl_n�� Q- �. tT- .- c�9�1' 1:rA �lPM_iz_± ' R�` �tt,_�.i_► ------------------------------------------ t ------------------------ -----------------------------------------------------------T�_R ►.-r----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �""� f --------------------- --------------------------------(Owner and/or Contractor) (signed)------ --------- -------- ----- BY= Tale --- ---------- - - -------------- ---------- --- - ----------- - ------------------------------------------------------- - ---- - w_(Plot plan, showing size of lot, location_of,sys+em in relation to wells,.buildings, e+c., can be placed on reverse side). w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ` '— ---------------------- -- --------- -- DATE.------- ------ REVIEWEDBY------------------------- -- --------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------- -' -------------------- ---—-------------------------- ------ DATE--------------- -------------------------------------------- Alterations and/or recommendations:-_.._-'--HT.4—JAI-F ---�0T-----llilS I9~LL R"-____. __-1_7"c ------------------------ Alterations ._" -------------- -- -------`"r� a'-----------------•---------- ----------------------------- -- -------------- --------- L----- Date---------- --"l �.� ----------------------- FINAL INSPECTI --------- SAN JOAQUIN LOCAL HEALTH DISTRICT I601 E.Hazelton Ave. 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CU-