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FOR OFFICE USE: 1, ------'- ------- Permit No. ------- ------- --- (APPLICATION FOR SANITATION PERMIT '--__"--- °� (Complete irs buplicete) Date Issued4_5 t This Permit Expires 1 Year From Date Issued' ; ________•- ----------------- --------- Y • - Applicafion`is hereby 'made to the San.Joaquin Local Health District for a permit to construct and install the work herein de crib d�12. IV This application is made".i'n compiianacewith County Ordinance No. 549. , /V JOB ADDRESS AND LOCATION dACKTCI_I R - NO -t.- ` -1 i+ ---------- '---------- Phone Owner's Name-------------- r[ - ----- ---------- ------------ - �"� 7 ° ----------------------------------------------------------------------------------------- Address------------- -- . - ---------- ----------------- --------------. Phone---------------------------------- Contractor's Name--- __ }— _ Q ------------•---------------------------------- Motel Court ❑ Motel ❑ Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ T Number of living units: "-�__._ Number of bedrooms "_ Number of baths __!-___ Lot size ----AC_I_;E_OqW�------------------------ Water Supply: Public system E] Community system [:] Private. Depth to Water Table ft. •+-� :n Character of soil to a depth of 3 fees: _. Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑YS Clay El Adobe❑ Hardpan ❑ No. New Construct. No FHA/VA:-Yes ❑ _Nom,, Previous_Application Made: (If,yes;dclte --.-- --1 , TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--____---__._.__Distance from foundation--------------------Material------------------------------------------------- --------------- r --------------------------Size depth--------------- ------ ---Capacity No. of compartments_. -� Disposal F� Id- Distance from nearest _-3---Distance from foundation----fQ--------.Distance to nearest loft line__,.=5______._ rten th of each line-_ - "-- Width of trench------ �.."-----y------------ Number of Imes-i------------------------------- Type ------------- g T e of filter m,aterial___rCY�,._. Depth of filter mateiiai.__..20�---__`_---Total length___.______/ �______------_-__-. Yp , t Seepage Pit: Distance to nearest well_°___ _________ __tDistance from foundation-----------------!_-Distance to nearest lot line____--______..._ Number o pits-� - Lining material Size: Diameter-- -Depth.:. f ❑ g'material--- --------------------------------- -froml Cesspool: Distance nearest well_________________Distance from foundation..__________.______.Lininels. ❑ _Liquid Capacity---------------------- Size: Diameter__` -------- ---------- Depth g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---_._____.___--__________------El ---- - Distance to nearest lot'line------------------------ ----------------------- ----------------- --- --------------- - Remodeling and/or repairing [describe}:_. - ITl ��-- -- 'S�� T�-P-R-0 {-77 . -iQ�-------� Q L Ackf- I-1_tv_—-----L)AID-- ----------� - L - -r. �A - ------------------------------ �--- •- --------------- -- ------ --- ---=-------------- --------- --------------------- I hereby certify that;l have piepared this application and that the work will be done'in accordance with San Joaquin County t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I' -------(Owner-and/or Contract Y St ned C if--- -�� - ----- ----- ¢ --= = -- =------------------------------- f - (Title)---------------------------- --- ------ - ------- -------- ---------- -------------------------------------------- ----- -- (Plot plan, showing size of lot, location o m in relation a--wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Y---- ' ----------------------- ----------- DATE ------------------------- REVIEWEDBY -----t✓;�------- ------------------------------------------ --------- --------------------------------------------- DATE----"---------------------------------------------------- - BUILDING PERMIT ISSUED-----------.f---------- --------------------------- DATE--"----='- ------------------ ------------------------------------- and/or recommendationst._.----------- ---- - -- y - ( ----- I ------ ------ -- - -- - ---' ---------------- ------------------ ----- 3 -, s �yQ --- --- -- - - -- -- � Date---- ---:=----- --- --- - ------------------------- FINAL INSPECT16 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 sycornore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California � F•.P.co.