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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 2 �.f (Complete in Duplicate) --t` Date Issued �" -------- _7e_,- e ..✓ ._-- This Permit Expires 1 Year From Date Issued ....��. '/ �3 '——Ioplication^is hereby made'to the San Joaquin-Local-Health'-District for a permit t construct and 'snsta t work herein described. l .TlOBa�D t��s._made i�coynp�iar,� itounty Ordinance No. 549. RESS-AND LOCATION- x-)------------- Owner's -----------•-- I ,r� � [ I Owners Namr_ -1�_,t Phone Address ® .... .�.f��► ._�. _ 1 ------ 1 / G1�1�11/Il. Contractor's Name---------` a�. ( � --------- ------- .ams--- 1-AC-------------------------- Installation •--•-------------------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t . Number of living units: .------ Number of bedrooms y-_ Number of baths __/.... Lot size ------------------------------ Water -- e-d----------------------------Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table 2.Q.. ft. Character of soil to a depth of 3 feet: Sand g Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ 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 permitFed if public sewer is available within 200 feet.) l Septi ,Tank: Distance from nea st:well_.1k41t__Distance from foundation--/—r-I---- Mater�ai-�1�.4`A�7 No. of com a•rtme11ts.. --------------- iSize. . �l. . _ Liquid deth. --------------Capacity-800,0P4, 6� - - w Disposal Field: Distance from;nearest wellAW-A) Distance fro-wfo.`ndation.l`-5....._....Distance to nearest lot Iine.1. -__-_-. �. Number of IinesM-two _-----------------Length of each•l e-6��_ 16Q Width of trench.-- ��.-____ / h y� --------------- Type of filter mater.ial.. . ._ ._.--.Depth of filter m`�terial_...�. ..._.... ...Total length__� "�_.1t1....._..._ Seepage Pit: Distance to Wean s well---------------------Distance from4foudation_-_.....___._.-_...Distance to nearest lot line................. ❑ Number of pts---- ... ""--Lining rriater al__�r+M-1. :Size: Diameter--------------.--------Depth-........._.._....-._.._-_.... Cesspool: Distance from neo est well .------------.,_Distance fr ` -.foundation....................Lining material-------------------------------_-.--.. 0 Size: Diameter- --------------------- -- ---Depth-►�`--5---------------------------------------------Liquid Capacity gals. r Priv Distance from nearest well-------------------- v Privy; ,- ---------------- -�,Di tante from nearest building-----.--------------------------.-.-___--. ❑ Distance to nearest,lot ire----------------------------------------------- ---------------------------------------------------------------------------------- Remodeling and/or repairing (des cibeI.- • ZX-11151411)y-----15Y_P?---------------- ' ------------------------------------------------------------------------------- - ----------------------------•----------------------------•----•----- -------------- -------------- i , ------------- ------•------------ ' - ------------------------------------------------------------------------€----------------------------- ' I hereby certify that I have prepared this application and that th ork will be done in accordance with San Joaquin County I ordinances, State-18w—s, rules and regulations of the San Joaquin Local Health District. t I (Signed)--------------_-- A----- --------A------ ---------------------------------(Owner and/or Contractor) r � $ - �-�' , i s---- - ----- Title Y' --•= ( ) (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be place on reverse, Ita'e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE- -- .'. 7----------------------------- REVIEWEDBY---------------------------------- ------------------------------------------------- - --- DATE----- - ------------------------- --------------- BUILDING ---- - BUILDINGPERMIT ISSUED------------------ ----------------------------------------------------------------------------------- DATE------ ------------------------------------------------------ Alterationsand/or recommendations------------------------------------- --------------------------------------------------------------------------------------•---------------------------------- --------------------------------------------------- ----------------------- ------------------------------------------------------------ -• ---•------------------------------------------------•----------- ------------ --------------------------------------------- ------------------------------------------ ------------------------------------•-------------------------------------------------------• ------------------------------------- I - ------------------------------------------ = ...... ------------------------------------------------------------------------------------------------------------------------------------- .................................................. ------------------------------------------------------------'---------------------------------- ------------------------ I FINAL INSPECTIONBY: .. ---•---------------- Date---------------�.'_y`--0. -. --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F�P.Ca. i'.