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FOR OFFICE USE: 9.� = ---------- -----------1-------- wa ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------- ---- ------------------------- --- (Complete in Duplicate) © /5=� -------------------------------------------- This Permit Expires 1 Year From Date Issued 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. _ JOB ADDRESS ALOCATION____�C._ _. /___ - --7`- -- ------ f-- --- - - Owner's Name__ _ - -_ � = �Phony^_ 2 /^ _ Address................... - . - -- ---C r - r--- t Contractor's Name 4��_.. ___1k- - L: ±•C ---- - - nt House Commercial Trailer Co ❑ Motel ❑ Other ❑ Installation will serve: Residence [�partme ❑ ❑ .� � Number of living units: Nu er of bedrooms _Number of baths 1 Lot size ------ 4 �.- '---------- € Water Supply: Public system ommunity system.❑ Private ❑ Depth to Water Table ft, Character of soil-to''a-depthrof,3Yf-eeti and❑a, Gravel ❑,,Sandy�Loam,❑ CIay�Loa,m_❑Clay"❑ A ,obe ardpan ❑ -, - . ---�---�. Previous Application Made: [If yes,dCIA----- --------1 No ❑ New Construction: Yes ❑ N HA/VA: Yes ❑ �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic +ank or cesspool permitted if public sewer is available within100'feet. k frorl5- undatiL quidd p ,Material Capacity nc� r -- -- W-- path =----------•------------'cal 41��7ti Not of compartments t------------------------well - --------=-----pze_�-=---_-_ - - � -- al •el�: �L}istance from near t well Q.i1�__Distance from foundation__ 'R �___ --D stance to nearest lot I��e__��--.? umber of lines__' __ ._..� __.___ -Length of each line�& - /,idth of trench_ `_____ __------ k _____ •, Type of filter materr (,. p -�- fiTotal length---------------- - - Q 1 D,e iii of�filter-mater al-___-- G Seepage Pit: Distance to nearer well_ _ oCtl_ _ __D.istanc from,foundation__;�__�----_---1:-Di�ance to nearest�lot Number of pits ------ v i . - 10: _ Depth-iC+.meati--- ---------- Diameter___--. - € , x Cesspool: Distance from nearest well-------- Distance from oundation ________________ Lining matena!_____.--__-.__ -.------------------- F .____._ _____._._ V4 Lini matenaL_-__ .(4_. _ . ❑ $ize: Diameter--- Depth------- --------------I------ - ----------------�Liqui� Capacity------------------ -----� gals. r Privy: Distance from nearest well___----____________---_ ___._.----._.-____- -Distance from n a$st'building.._._...___________._______--- ❑ Distance to nearestlot line:..................1..... Remodeling and/or' repairing (describe:____ .__ -"+ --- ;' = ; --- --------••--------------- ----•----------------•------- - - ------------- -------------------------------- f ` ---- ------- ----------- ---------- ----------- ---- - t. q ._ y t - _ I hereby certify that I have prepared this application and that the work will be d"one in accordance with San Joa urn ount ordinances, State laws, rules and regulations of the San Joaquin Local Health ,pis+nc+. Signed �----- -- ---t-- Contractor) ( g )----------- --- '3 - SEPTIC TANK ERV C� �, ,, $y'2911 E.AAtneK Rt , � - --- ----- (rile) (Plot plan, showing size of to+, location of system in relation t wells, buildings, c., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY . s APPLICATION ACCEPTED BY-------- ---- --- . -Q ------------------------------------- DATE----------4 -�a REVIEWEDBY------------------------------- ----------------------------------- ----- --------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- - DATE.--------------------------------------------------------- Alterationsand/or recommendations:------ -- ------------------- --------- - ----------•-------------------�----------•------------------------------- ------------------- ----------------- I a ------------------------- -----•-- --------- ------- ------------------------ ------------------------------- ------------•----------- ------------ ------------------- -- ------------"---------------------------------------------------------------- - --- -------------------- ------Im-----...---�-�------ --- ----------------------------------- --- ------- ----- ------------------------------------ ---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL ----FINAL INSPECTION BY:------ - .. — =- - Dae-- ------- � � ---- - ---------------------------- SAN - JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street i F Stockton,California t Lodi,California Manteca,California Tracy,California i f+ F.P.CO.