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FOR OFFICE USE: -------------- -------------- ------------- Permit No. . J _.c APPLICATION FOR SANITATION .PERMIT 'I --------- ---------- ------------- (Complete in Duplicate) / Date Issued ?-= ----- ---------{- --- - "'""'_''---. _" :. "This Permit Ex fires_1 Year Froin Date Issued D�� ^ `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_ X57~ BF'� F JOB ADQRESS AND LOCATION--- _-- /Vi ------ 1LI1l�j----�" ' ----- - 1 �f }lE r!� L _ � �' Phone--- Owner's Name--------V_-1_------- - t•---" ----- - 1 .11 a, ------------------------------------ Address-----.Address-----•--------- _.. _ / .fix------ -----•----- ------------ ------- ---- Contractor's Name--------------•-~--- � �----------- --- --------------- --------- Phone -• - �f Installation will serve: Residence ( Apartment House F] Commercial E] Trailer Court ❑ Motel ElOther E] offji in -_J_ Number of bedrooms / �� Number ofyliving=units: __ _ ___ Number of baths - Lot size __,/ -- ---------------------------------•--------------- Water Supply: Public system ❑ Community system ❑ Private$, Depth to Water Table ft. Irk^'- Character of soil to a depth.of 3 feet: Sand Gravel ❑ Sandy Loam El Clay Loam ❑ Clay El Adobe g Hardpan E]9 r�✓` Previous Application Made:- yes,da�e------ No'o New Construction: Yes E] No�, FHA/VA: Yes El No TYPE.OF INSTALLATION ANDS SPECIFICATIONS: I per (No septic tank or cesspabmitted if public sewer is available within 200 feet.) t Septic Tank: Distance from i nearest well-- _____________Distance from foundation---_-----------__.Material---..__--..-_-.---:_-----.-__-__---------._-... ❑� t Wj? ---- - -----Liquid depth----------- --------------Capacity k S No. of 'compartments - ----�=----------- Size------------ - - - --- ---------------- Disposal --------------- � Disposal Field: Distance from;•nearest welL_ft� _....Distance from foundation__.---,.----Distance to nearest lot l fe_'/i� _-__.-. m -- ' Number of Imes=_-(�'Y�. -... . --------Length of each line___ Width of trench.:'._._.__ ___ S.?` _ �. Type of filter.material--- -- --------------- Type of filter material-__-�_ .....--- _---Total length--------- -............................. '( to nearest lot line--/X Seepage Pit: Distance to'nearest welf-.�.lQ.__--_ ---Distance"I'm ndatiori___ f! z Size: Diameter--.33-1 . De th___ z�__-._...------. Number of-pits_.L` -�.�.Lining material-__ --- Diameter--.33-114----- p , Cessp'ool'-Ditahce-fl'om-'nearest well:---------------_Distance from foundation- ---------------- Lining material----------------------_.._--.--_--.-. t ❑ Size: Diameter----- --------------------- ---------Depth------------------------------------------ --------Liquid Capacity- ?---------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-#------ ._-___-_------_--_.--__.__. ❑ Distance to nearest lot line--------- ----- --------- ------------------------------------------------------------------------------ Remodeling ---'•--•----------------------- Remodsling and/or repairing (describe):------ ---- -_-- ,'� ------ ----- --------- =----------------------R_ -------- ry _______________________________________________________________t i--_----.--._---------_.--._- --------------------------- --` __'__--__--_-._--------________--------_-_-_---._._---_____---------------______...________._....._ --------------------------- ------- - ------------------------------------------------------- - { i _ _ ___________ _______--._-_-____-____.__._____.___.._________.________________-.-----------____________--- ._ .___--_-___ _.._-.___---.----__-.___---.__._--._-_-.---_._-. ____ ____ _ ______ ___ ___ _ __.-_______ I hereby_ __certi__ __ fy th_.at_ ve prepared this application and that the work will be done in accordance with San,Joaquin County ordinances, State laws, a d ules and�regula ' ns of the San Jo Local Health District. E (Signed)-------------- ---------- ---- - �-- ---- -- - ----------- -------------_--------- (Owner and/or Contractor) By:----------------------- --- :-C. ------ L-C_.�_--- -- Gil. �Tit1e) - ---- [Plot plan, showing size of lot, ovation of system in relation to ells, buildings, etc., can be place n rever%se side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY--•..................... A DATE- 3 �r ..��----------------- REVIEWEDBY------------------------ --------- -------------- ------------------------- DATE -------------------------------------- BUILDINGPERMIT ISSUED----------------------------- - - DATE--------------------------------------------------------- --- Alterations and/or recommendations:-------- ✓� �� '/` v - ; -------------- ---------------------•-------------------------------- ------------•---------------------------•----------------------------------------------------------------------------•----------------------- - --------------------------- ------------------------------ - ------------------------ --------- ----------------•------------------------------------------- ------------- -------------------------------- t _FI IVAL7INSPECTION BY: � --------- Date -�� - =--------------- ------- ---- F "SAN JOiAQUIN LOCAL'HEALTH"'DISTRICT`-_��.__.�. -- 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.