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�R OFFICE USE: 7 2 S- �:�--------------------- --55 ' -------------------------------------------------------- APPLICATION F(5R SANITATION PERMIT /Dr,, it No. ....2-a... ----- ---------------------- ---------------------- (Complete in Duplicate) „ _... ,. 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 ' all the work herein described. This application is made in compliance with County Ordinance o. 549. l JOB ADDRESS AN O ION_ --------- - -------------- ------------------------ S'c I - Phone4�774,1-�1 Owner's Na ----n---• - - - - ------- ----- - --- ---------- ------ A Address---------- t s --- ------ - f a � c - --------------- -------------------------------------v------- Contractor's Name-- -------- ' / Z / .-� -- -----= - �`•_�- Phone._ _. A--- � Installation will serve: Residence Apartment HouseCommercial ❑ Trailer Court [3Motel E] Other E:1Number of living units: I--- tuber of bedrooms___ Number of baths __1.__ Lot size ___�,�___ --- -------------------- Water Supply: Publics stem Community system ❑ Private ❑ Depth to Water Table. ft. system ,.�.�..,r -- Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ d`obe �dpan ❑ Previous Application Made (If yes,date---_.---------------) No ❑ New Construction: Yes ❑ No�(_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or lesspool permitted if p blic sewer is available within 200 feet, r t w Septic Tank: Distance from nearest w I4_ �_ istanc� from fo10"un ?Ca rp �'No. of compartments_._. ----------------Size3___ _ iuiddepfhh__. _ --___._.__ pacity----- --�----- Dis oral Field: Distant from nearest well. ._ )istance ----- 7-- ram founds i n n i p _ __li..__-Distance to nearest lot line___.:_5 Number of lines_______ g i �Rs Length o t ealine_._f. _ ___-_i_ �_�.Width of trench.___s�_� --______f_______ W Type o filter, material Depths ' filter4mate __.____.!_- 1----_Total length______------------------J8_____------ Seep e Pit: Distane to nearest well___ Dista'n(c ram f undation_�Q_ ___.Distance to nearest lot line----- 0 I Nu b'eir of pits.----I----------------Lining maters l___- -__-- Size: Diamet'r------- Depth----_�_ ---- iiif i� :a Cesspool: Distance from nearest well_________________Dist% from f undation_.___-___-_--._..__.Lining material___.__._.___-----_.__.____,_________- ❑ Si�e: Diameter---.. � -- ------- -----------De . 'r -------Liquid Capacity-- -------------------------gals. �` --- -- Privy: Dista fromearest�ive'll- �._.+________ _______ __ ----------Distance from nearest building_____...______.-_______._._.__.�________. ❑ Distance to nearest lot line--- ------------------ i--------- 11 - (b --:---------------------------------------------- •---------- Remodeling and/or repairing (de�slcribe)_______________ __ ------------- ----- 1------ - :- I i--------------- � - J--------- -----)-------- -------------=--------------------- - ---- ----- " ------------------------------------------------------------------------------------------------ ------------------------------------------ `7r----------I------------------------------------------------ -------------------------------------------------------- I hereby certify t t I ve prepared this applica ' -and that#lie wor w' a done in accordance with San Joaquin County ordinances, Sta a. s, ules regulationseof' an Joa In a H th District. ---------- -----R--------.------------- a Cont actor) --- ---Title By:--------------------------------------------------- --------------------------- (Title) {Plot plan, showing size of lot, location of system in relati ells, buildings, c., c in be placed on reverse side}. i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ✓ - -------------------------------- DATE--- 7 e?5=6� ---------- --- ----------------- ------ ------ - REVIEWEDBY------------- --------------------------- ------ --------- ----------------- ---------------------------------------------- DATE--- -----------------------------------I------------- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE------k--------------------------------------- ------------ Alterations and/or recommendations:____ " " l -----.- ----- ----------- ------------- ---------------------------------- -----------------------�` ------- G�,/7 �'zS``� ": ---------------------------�------------- -------------------------- -------------------------------------- -------------- ------- ------- --------------------------------------------------------- --- --------- -It---- ------------------------ ' ! ------------------- ---------- ------------ • ---- ---------- ----------------- ------ ----------------------------------------------- --------------------- ------A--------------- ----------------------------- I FINAL INSPECTION BY: ._. Date-------- .J__. ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kasellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California K.P.CC7.