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FOR OFFICE USE: = =r> ----- -- ------ ----- Permit No. -- APPLICATION FOR SANITATION PERMIT �/- o - ----------------------------------------/,-;40"---- (Complete in Duplicate) Date Issued ----- --- ------------------ --------------------- This Permit Expires 1 Year From 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 AND LOCATION___ //V4----- ¢ P�s�G----------- ------------------------------------------------------------------------------------------- 11-2%,100097 Owner's Name----G -�'1. y L ,/� - ; Phone- -•------- -----•----•-••---- Address---•---..C2.1 -_e®---•-- F��-��--------�!` 1.4---------• _... Contractor's Name------ -- j9 s — --------------------------------------------------------- --------------------- hon --- ••---- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court Motel ❑ Other Number of living units: _ _ Number of bedrooms a?•.- Number of baths _/-- Lot siz -� ----- -----•--------------- Water Supply: Public systemw�Community system [] Private ❑ Depth to Water Tab6f4 Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rg-'Ilardpan ❑ Previous Application Made: (If yes,date............:.......) No `New Construction: Yes ❑ No [A—FHA/VA: Yes ❑ NoZ;j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tan :;, Distance from-nearest weld-----------------Distance from foundation--------------------Material----------------------------------------.._-_-._. No. of compartments--------------------- ----Size-------------------------------Liquid depth---- --------------Capacity-------------------- Disposal Field:, Distance from nearest well._ .-Distance from foundation_f4V-----------Distance to nearest lot line ------- 1��' Number of lines__________ ___ _�__.-Length-of each lir e-_ - ------------------_ Width of trench_ � ------------------------ Cc _____.____.._ "__.___ f Type of filter Materia � ?0--- of filter material__ ____j___Total length__ y ________________._____' Ap----.-_-.Distance to nearest lot line_._ Seepage Pit: Dis#ante to nearest well..__':" '_ .{Distance fr fo dation- rs [jP� Number of pits----- ---------- Size: Diameter-J-.;?----.-----De th_1-�_- _ - _��. __._._Lining material_ p ,/ -- Cesspool: f Distance from nearest well-----------------Distance from foundation---------- -------Lining material-------------------------------------. ❑ - .. ,Size: Diameter- -------------------------- - ------Depth----------------------------- --- - ----------------Liquid Capacity----------------------------gals. ` _.. _ Privy: Distance from nearest well-----------------------'---------------------._Distance from nearest building----------------------------------------.. ❑ ft Distance to nearest lot line--------------------- = --- --- --- -------------------------------------- ------------------------------------------------------- Remodeling and/or repairing (describe):-----------------_0...... ---------------------------•----------------------------------•-------------------------------------------------------------------------------------------------------- --------------------•---------------- ----------------- ---------- ------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 rules and regulations of the San Joaquin Local Health District. Si ned ��'� !� �� ----------------- - --- ----- `(ev7f3r r Contractor) ( g ------------ By:--------------• -------------------------------------------------------- ---------------(Title)- ��-'------- - ---------------- (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be pact ed on reverse,side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------.----------- DATE---- -- --__ - -. REVIEWEDBY--------------------------------------------- ...... --------- ----------------------------- DATE----- --- ---- ------ --- ------ BUILDINGPERMIT ISSUED--------------------------------- ---------------------------------------------------- -- --------- DANE Altert �na_G d/ Z/.o. recommendations:_"__________________-.......__ -------------------------------------------------------------- aal-ate------- -- - - ----------� ---------- == . ------711 ----------� ~ ------ ---------------------------- --------------- ---------------------------------------------------------------- -----.r_. -------- FINAL INSPECTION BY:............. ---------------------------------------- Date---- - ----71ZI-7�1--------------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.