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FOR OFFICE USE: 8'/3- 4,5' 9.,� J�6-&j 0 --------------- APPLICATION FOR SANITATION PERMIT Perm No.------------------------------- ...1 -_ ...L. 1 -------------------- ----------------------------'---- -- (Complete in Duplicate) / Date Issued __-.-�-------_�6 S i ---------------------------- -------------------------- This Permit Expires_I Year From Date Issued # Application is hereby made to the San Joaquin Local Health District for a permit to con fr ct and install the wo k herein described. This application is made in compliance with County Ordinance S49. JOB ADDRESS A -LOCATIO ._-/��f -------- -- --------- - -------------------------------------------- Owner's Name ' = - -- -- Phone----------------------- ------------ Address-------------------------- -----------Address-------------------------- ----- ---- - --------- - - --- - - 1 -------------------------- Contractor's Nam =-- ----------------- -------------•-- - - '_��_ - ----- Phon - --------- 1 Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: -t-.--- Number of bedrooms --umber of baths _/--_ Lot size ._ ----------------- Water Supply: Public system Communify system ❑ Private ❑ Depth to Water Table ------ _ ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ =% Previous Application Made: (If yes,date......... ------- } No,❑, -New Construction:jes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)I S is Tan Distance from nearest well------- Distance from foundation--------------------Material-----------------------------------------_-__-. r { of compartments'. -------:- Sizet 1-`-•--------------------•---Liquid depth--------------------------Capacity-------------- ------ -�istan ce from foundation-- -- ._ r...... to nearest lot line--- -- Number of lines__ ___--_- __- �_dlfl__Depth Length of each line,"---! Width of trent I- 1 . - Type of filter material of filter material---- -------Total length---. - ---r-----_-_-------- -Seepage Pit: Distance to near t well-A Distancrom foundation----/-9.---_-_.Dist nce to nearest lot line--..;r Number bf;pits-_ g p f -'----- --'-_-'--Linin matercal Size: Diameter-_-* .- ----� --Depth- Distance from nearest well--------------__Disfance fro oundation_ -------_------- Lining material----..-----.--.-.---._..---.--------- t ! EJ Size: Diameter------- --------------Depth ---I---- ----- ---------------------Liquid Capacity ------gals. c Privy: Distance from nearest.well------------------------- -----------------------Distance from nearest building------------------------------------------ 171 Distance fo nearest lot lire--------------------------------------------------------------------------------------------------------- ----------------------------- 1 Al �'Remodeling and/or repairing (describe)--------- ------------------------- =�---------•-----------------------.----- ------------------------------------------------ ----.. � . ----------•---•----••-----•----•---------------------------------------------------------------------------- -----•--------------------------------------------------------------------------------------=--------------- l - -------------------------------------------------------- -- ---- �., I ---------------------------•------- f .. -----------•----------------------------------"_-..----_-_------------_------------__------------------------------------------_----------_---------"_------...----_----------------_--------------------------------------.- pf I hereby certify that I eve prepared this application and that the work will be done in accordance with San Joaquin County " Y ordinances, State laws, an_Vkyles and regulations of the San Joaquin Local Health District. k c-� f (Signed) 2,y & 11,141 - - ---.--- r Contractor g - ------------------------------------- - ---- ----- ----------------------------- SE�TIG- "`t'AIVK SEF2VtG� < t 2915 ,MineLAve Hfl -X41------------------ ------ -----------------(Title)-------------------------------------------------- ------------ By! - ' (Plot plan, showing size of lot, location of system in relation t wells, buildi gs, etc., can be placed on reverse side}. I FOR DEPART ENT USE ONLY - , r APPLICATION ACCEPTED- -- --- ---- --- -=-- --- - --------------------------------- DATE--------- - - ------------- REVIEWEDBY-------------------------------- ------ ----' ---------------------------------------------------- DATE-------- ..........---------------------------------------- BUILDING PERMIT ISSUED------------- -r- ' F T ------ ------------------------- --- -------------------- Alterations and/or recommendation ------- -- ; --------•------------------------------- x' -----------------' ' - --------------------------------------------- ---------------------------------- - --- -..... - r FINAL INSPECTION BY _n_....-�-.- Date...... --. -_- Z - 4 t ----------------------- . 'SAN-JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street a Lodi,California Manteca,California Stockton,California Tracy,California F.P.Cq. - 1