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r VUK (JII-K-L USE: s ----------- ----------------- ---------------- ------- -------------- -- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...!_. 5 --------------------- ----------------------------- {Complete in Duplicate} k --"-------- --.--- This Permit Expires 1 Year From Date Issued--- Qate issuedJ-f_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install theOCI h� acrbed This application is made in Compliance wi County Ordinance No. 54 e JOB ADDRESS ND LOCATIO ��'�"7/�i`��,�i- - •, Owner's Name_. - ---------` - - ------ ---------- -----=---------------------------- -------- -- �/FJ. ��F/-/' Phone a ------- .--•--- 1 Address-------- --------- _.r__ - --------- --------------------------------------------------- -••------ --- -------•-- ---- ` Contractor's Name ------ Phone----------------------------------- Installation will serve: Residence ®_i partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _ __ Number of bedrooms ._0�' Number of baths -2--- Lot size II { Water Supply: Public system ❑ Community system ❑ Private to Water Table t. eft. f. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan UQ- -r I Previous Application Made: (If yes,late------------------ No R?"' New Construction; Yes R�'INo ❑ FHA/VA: YesJUo-'Tlo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p;rmitted if public sewer is available within 200 feet.)f Septic T nk: Distance from nearest we --- A&_--__Distance_from foundation__,��_..._.__-Mate`al�!-.e_ /°'--- .� .�' ---------- y r No. of compartrrienis._ ----------------Sizer _. Liquid depth.....��__.---------------Capacity_/,,%� 2---•-- i, Disposal Field: Distance from neares w ----- —� / P t��_""`Di's�ance from foundation ��___�:D�stanee to nearest Int fine_._ ______ Number of lines_____ Length of each line 9 -- idth of trench-�_-_---_- Type of filter materialZ, of filter material-__ __ .p-____-_-Total length_ 2 �,q� Seepage Pit: Distance to nearest ,ell_.___6-1.4e-Depth "�sfance frpm fo ndation,V.1-0---------. is nc�e,�arest 1 [� Number of pits---._c:r�:._a_;__---Lining material_ ---Size: Diameter_ Depth '°_.- - ------ - ------------ � . Cesspool: Distance from nearest well________I-_._.-_Distance from foundation . --------------- --------`- ---Depth----------------------------------------------------Liquid Capacity- --------- ---------------gals. Privy: Distance from nearest well--------.! ___._.._Distance from nearest building-------- Distance to nearest lot line... s -------------- - --- i t i/Remodeling and/or repairing si ----------------------------------------------------------- (describe):_____- _4__ _ -------------------------------------------------------•--- ------------------ i - ---------------- - ------------------------------------------------ �. -- ------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepare this application a d khat the work will`Ue done in accordance with San Joaquin CountyI 'ordinances, State laws, and rules an regulations of the San Joaquin Local Health District. `i (Signed)-,, ,� dr�'(� ---- -- --- ------ - - - - --------------------- I ------ ---- ------------------------------------�r Contractors B ----------------------------------------------- ---� ------ -- - - �= - - - - - -------- - - - ---- - - -------------- -- --(Tit (Plot p1an, showing size of lot, location of.system to re on o wells, buildings, etc., can be placed "on�ever4e sides. + 4 FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED-BY� _..�-- - - ----------------- ------------------------------ DATE-'"�"_-=�-��---- --------------- ---- REVIEWED BY DATE ----------------------------------------- BUILDING-PERMIT ISSUED_________________________ _ - --------------------------------------------------------------------------- DATE----- -- -------------• ----- - - - Alterations and/or recommendations______________ - t° i " -----•---- ------------------------------------- ---•---------- ----------------------------------------------------------- - t ------------------------------------ -.j f _ -1---------------------------------- -------------•-----------•------------------ ------------- - -- ------------ -----------------------t --------------------------------------------------------- -------------"-------- ------------------- ------I----- - -----------------------------------------=- FINAL INSPECTION BY:. . . ------ -- -------- Date �� - • SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:shoo Ave, ti300 West Oak Street s-t -1.24 Sycamore Street 4 205 West 9th Street � Stockton,California Lodi,California' i 'wJ � ti ' Manteca,California" Tracy,California