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FOR OFFICE USE: s - ,y --------------------------------------------------------- --------------------------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. . �� ------------ --------------------------- ---------------- (Complete in Duplicate) ---1 -b-, '- A Y.40This Permit Expires 1 Year From Date Issued Date Issued -�y-�.-_ -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and insFall the work herein described. This application is mad ikE07m ance with County Ordinance No. 549. �6-7-2�Fo-'f f LCE}L-0lV 300 ��jj� Q JOBADDRESS AND LO -- ---• IfDQs aF �7[ ��MSR- Owner's Name .------• �Z Phone ------------------------------------ Address----------------- vlLr-------6 r� Contractor's Name------.05711U(� � Ph .--- � / d6$ --A- --•� -. one. .�-�----- -- Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --,----- Number of bedrooms,___- Number of baths 7—Lot size -__- .---. � -------------------- Water Supply: Public system ❑ Community system ❑ Private eDepfh to Water Table 00 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cfay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------- -----I No 0�New Construction: Yes 2�No ❑ FHANA: Yes ?T�'No ❑ TYPE .OF INSTALLATION AND SPECIFICATIONS:-— _ __ (No septic tank or cesspool permitted if public sewer is available within 200 feet.]TT— Septic Tank: Distance from nearest well---?-Q----Distant, from foundation--/Q-----------Materi D/VrCR-ETA No. of comparfinents--------2 --------------size�f�-X-11-X..5Liquid depth--.,' ..---Capacity..Zs Disposal Field: Distance from nearest well----.57 --_-Distance from foundation-10---.----.Distance to nearest lot line---'-5 ---- R4— Number of lines--- --------�-------------.._Length of each lipWidth of trench------ -2'fH--- ------- - -- Type of filter material---AO-C-155N.--Depth of filter material --___1-7_r-.__--_..Total length_____-- ---f-9 SeepaP-1`1 f: Distance to nearest well ---�_q---------Distance from foundation----/Q--....-.-.Distance to nearest loft Number of pits-------1-------------Lning material_-�Q�� Size: Diameter_y-�--7�_____-.Depth ----------- Cesspool: -.--____.Cesspool: Distance from nearest well__--------------Distance from foundation--------------------Lining material------------------------------------- El -----_-----__--_--------.-- ------❑ Size: Diameter--- ------Depth--------------------------------- -------- - ------Liquid Capacity---------- ------------gals. Privy: Distance from nearest well-- -----------------------------------Distance from nearest building.______---------------------------------- .. 0.1% Distance fo nearest lot line---------------------- -------- ------------------------------------------------------------------------------------ ----------- ------------- 6-3-6l-. Remodelin gAand/or repairing (describe):-----S�5T1�M-----1�5XAie-LD---__-AEFQg�--_165&Ncx..._-QF•--_--MgMiT.-�------ ------------------- � ------toCK-}--------4> &ci#---- ntF.-----hr-4wt-Rr 0----------- 't -a---------------------------------------------- --- - --------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------: --- -- `e {Owner and/or Contractor] ----------------- ----------------- ------ --- ----------------------------------------(Title)--------------------- - -- ------ --- ---------------- (Plot ---- ----------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- T-t- D_f---------------------------------------------------------------------- DATE------- - .------------- REVIEWEDBY----- ----------------------------------------------------------- ------------- --------------- ----------------------------- DATE------- BUILDING PERMIT ISSUED----- - -- �r _ DATE----------�----C-3---------------------------- �--^-----7------ Alterations and/or recommendations:_- ------- ----- ---------------------------------------- �G S--a' Pf- t/ /-�------Q�--- ----.-Z0 ` ISD-bt-7"rrQnt ------------- -------------------------------------------------------- - H tf--- ------------------------ --- - ------------------------------ --a c == ---------- -- ----------------------------------------------------------------------------------- --------------------------- ------ --------------- ------------ -------- FINAL INSPECTIs°• ,`--! Z Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r U.