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FOR OFFICE USE: ------- -------------- ,_----._------ _- ------------I�--. APPLICATION FOR SANITATION PERMIT Permit No. .cxDO - - --- (Complete in Duplicate) Date Issued -----9_ = � ------------------------------------------------ This Permit Expires 1 Year From Date Issued , Application is hereby made to the San Joaquin Local Health District for a perm) tofconst a and install the work herein described. This.application is made in compliance with County O dinance No. 549. 41 I / JOB ADDRESS AND LOCATION--- ', I>--.- __---u-_-=---- ---- /1, .. }sr SAF-f�'r �__--,5Q!D_ ,l Owner's Name--------y4n�e -77.f7'.0 :----------- I---------- ` / ------ ------------------------------------- Phone--':&-5' .1 ---- Add ress .I 1 �° . �X 1 -� -.i r�-. /`IIr 1� --------------------- Contractor's Name__ 2�r � AW-00-------�• 4p" e� -------- G^ '------------- Phone--�6�-8649-7----- Installation will serve: Reside nce �[ Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms :t�_ Number of baths I__- Lot size --------------------- ------ Water Supply: Public system� ❑ Community system ❑ Private ® Depth to Water Table /9). ft. Character of soil to a depth 'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam o Clay ❑ Adobe❑ Hardpan j4 Previous Application Made: 11(If yes,date------------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 1 k� TYPE OF INSTALLATION AND SPECfFICATlON5: ,(Nq sepfic tank,or cesspool permitted.if.pu6lic_sewer is available„within 200_feet.)p Septic Tank: Dis`Nof n com artmfrom a tst well=====----------- Distance from foundation_-_--.-------_-.._.Material-.k_._______._..__.-.--..-- ------____. r 1 Size----:------------------ _Liquid de th---------- --- ------Capacity .� /a p � Ilfrom nearest well-.�p......Distgnce from foundation_Zl�y�s-----Distance.to nearest I��e___ ___________ Disal Field: DNumabee of lines___.____________ _____________ ' . Length of each cine_._/Ilp_ ___________Width of trench... __..__.__-----_-_-___ -rype of filter material_Ql.r�f�, -Depth of filter material_.-. -.-____.._Total length_ ,fc��__----.___.__-____.-_-- Seepage Pit: Distance:Ito nearest well----------------------Distance from foundation--------------------Distanceao nearest lot line._--------.----._ I ❑ Number of pits------------------ ---Lining material----------------- --lsize dlDi,ameter'.-------------------/Depth------ -- ------------------ Cesspool: Distance from nearest well_---------------Distance from foundation,.-.-_ r-;-_.-.-.Lining material-------- --- ..----.-_.---. ❑ Size: Dial'eter- --- ------- --------------`--------Depth----------------- --- -----------------------------Liquid Capacity----------------------------gals, Priv Distance4rom nearest well----------------- ------_, -.-Distance from nearest building __ _ ❑ Mstancelto nearest lot line------------------ ---------------- -------------------•-------------------_-.:---- a Remodeling and/or repairing (describe):..... i f ! s4 3 X ----------------------------•------- r`-`---- -----------------------" ------------------------------- . -------------`-------------- , I hereby certify that I have prepared this application and that the work will 6e done in accordance"with San Joaquin County ordinances, State; laws, and rules and relotions A the San Joaquin Local a {District. -gl(Signed)------------- I��7 , 7-S,6,/.----(------dq,41S--------- --. Ow er and/or Contractor) By:------- - - - ------------------------------------------------------ -----(Title) - (Plot plan, sho�w�ring,size ofrla , cation of sysfem in relation to wells, bugs, c^ bezplaced on reverse side)... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --TR.-B -------•----------------------------------------------------`------- DATE------ -2 ._` . REVIEWEDBY--------- - --- -----'------- ------------------------------------------ ----------------------------------- --------- DATE BUILDING PERMIT fSSUED_A:------------------------------------------- -------- - - - ------------- DATE Alterations and/Wr &_omiiien " '_.------------ "'" ""w �". � ".."�" '. "�.~"~ �— - s � s ------------------------------- -------------------`---------- -------------------------------------------------------------•------------- ------ ----- ------------------------------ ------ ---- - - ---- ---- -- - - ----------------- ----------------- --- ------ ----------- --------- - - �I FINAL INSP I Date.....- z5 ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I� 300 West Oak Street 124 Sycamore Street 205 West 9tij Street Stockton,California I� Lodi, California Manteca,California Tracy,California I F.RC O. I! III I