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FOR OFFICE 5 _._- ..____-___- --_______________________ -------- APPLICATION FOR SANITATION PERMIT Permit No. .;� _ .� --------------------------------------------------------- (Complete in Duplicate) icr� __________________ i This Permit Expires 1 Year From Date Issued Date Issued ..-. ...___:... K 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. x-7.7 _ Qb~27 //4 b L&) ,F-f��c Ek Z_.,_1- ` JOB ADDRESS AND LOC. TION-S--141---Z r---- .a�/ �-f1---/i �/° �d/1 aFr'-fes ----------4912-- -�-1,�'t_U�l�� Owner's Name---------/ -. - , "zak1Ln- ---------------------------------------------------- ------------------------------------------- Phone------------------------------------ Address--------------- Contractor's Name--------------- .l7lf�PrlT`---------- ------ -----------------------------------------------------------------. Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: 7�%_ Number of bedrooms ____-- Number of baths .1___ Lot size _Y,44—e -______________________________________ Water Supply: Public system *Community system ❑ Private Depth to Water Table •—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e3--ffardpan ❑ Previous Application Made: (If yes,date.-.----------------.1 No R?,New Construction; Yes gq-'Rlo ❑ FHA/VA: Yes ❑ No Q, TYPE OF INSTALLATION AND SPECIFICATIONS: . -- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___ _.Distance from foundation-__ ------Material____� AI'!"°G�______________ No. of compartments______��'--------------Size -X..S<U_._-_:_..Liquid depth-___1�/Z-_--.._-_____-_Capacity...J:�f p____.___ Disposal Field: Distance from nearest weli__%JV- -..-Distance from foundstian___o___f_R_i-------Distance to nearest lot line-�__ ..... Number of lines-_____1______L________________Length of each line_-_- � ____ -Depth length-------9,f--'___ _______ _________ Seepage Pit: Distance to nearest well_____ ________________Distance from foundation--------------------Distance to nearest lot line______.._________ ❑ Number of pits______________________Lining material---------------------__Size: Diameter-----------------------Depth__---._____._.______--_-_________ Cesspool: Distance from nearest well_________________Distance from foundation..,___.----.------- Lining material__..__-____.____.___________________. El Size: Diameter---------------------- -------------De th------------------ ------------Liquid Capacity -------gals, Privy- Distance from nearest well---------------------------_--------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------------------------------------- --------------------••----------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------- r� ------• `sem �� L_L f ------------- •-------------- ------- �j f—( ----------------------------------------------------------------------------------•------------------------- -------------------------------------------- •----------------.._...---------------------------------- . . -----------------------•------------------------------------------------••---------------------------------------• .......•------•--------------------------------------------------------------------------------- ------------------------------------------------------------------------•-------------•-------•-------------- ---••--• -----------------------------------------------••----------------------------------------------------- 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 ru�rules and�reeg-ulations of the San Joaquin Local Health District. (Signed)---------------------AV-_L_e_-1----�t z_ns� -- -----------------(01wneitmvd�or Contractor) By: •� ---- - L� (Title) /�- ... y.... — (Plot plan, showing size of lot, location of system in relatio5l, wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- x.-----------------------------------------------•-•------------ DATE----i-Ca•--- ca REVIEWEDBY----------------------------------------------------------•----------------------------------------------------------------- DATE----------_---------•-------------- ---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE... -----•--------------------------------------------•------ Alterations and/or recommendations:---------------------------------- ----------- -1--------...---------------------- ---------------------------------------------------••--------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- --------•-----------------------•-------------------------------- ----------------- ------------------I---------------------------Q-----_•----- ... --- ----I--- -----•--------------------------------------------------•-------•-------•-------•------------------------------ -.---------------- FINAL INSPECTION BY:....... ...... .5----------- ----------------- Date---------4--- ----------.'------ I------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California EN-9 REVIeED■-99 r.P.00.1M 6.60 -