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FOR OFF�CE USE: —fie : APPLICATION FOR SANITATION PERMIT Permit No. - -- (Complete in Du licate P Date 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 install the work herein described. I This application is made in compliance with County Ordinance No..549. JOB ADDRESS AND ATION., ff rPhone_ S `'l Owner's Name -:- . . 12- __a_&.d_AL) Address-----•--------•- 1-•- -------------------------------- Contractor's Name 'l. r__- --- ` Installation will serve: Residence T�partmen�tz use ❑ Commercial ❑HTr� rCourt ❑ Motel ❑ Other ❑ .01 Number of living units: _j._.jNumber of bedroom- Number of baths V--- Lot size ___ - - ----- �"�--------- � �// -- - — Water Supply: Public system`Community system ElPrivate ❑ Depth to Water Table Ozft. l Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy'Loam ❑ Clay Loam ❑ Clay ❑ Adobe Iff Hardpan ❑ t ~'� New Construction: Yes El No �HA/VA: Yes ❑ No El Previous Application Made: -(Ifyes,date-._"--------- -i--1 No [j :" TYPE OF INSTALLATION AND SPECIFICATIONS: M (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) _ -'A r - Material---------------------------•--------------------- T - ------ - Se tic�T I�: Distance from nearest well_--..._--------.Distance from foundation..._ 9p No. of compartments------------- ------------Size Liquid depth Capacity �. ` - - 1-1 ... Di os�l F ld: Distance from nearest well- Distance from foundation--- . -_Dis#ance fo nearest lot line." I ` 1 Length of each linlial- Width"of trench.., --------- 4 - t�q Number of lines 4 g %, I -- Type of filter materia Depth of fil emat .... Total length----------------- -_0 �/--�} p _ �4 F7 Q ... . ; Via' �:.f t r See a e Pit: Distance to nearest well- .. 171� _Distanc rom foundation".. �� -_--.Dostan�� to nearest lot line"--_�Q � r .. - E Z p l Number of pits..-.�_ �'_...------Lining material.. 12_ , Size: Diameter. De th._ r rn .. .t Cesspool: Distance froni�nearest wail-......"""- ._Distance from oundation..__.:-__...__!-...Lining material--------------- -------------- ---- --- y -- ------ ----- -- Liquid.,Capacity gals. Size: Diameter-- ---------- ---- ---- ----------Depth-- --------- ------ ❑ Privy: Distance-froT nearest well_...-:_-:..-....___----------------------- --Distance from nearest building--...__...-----.-__-.._-..-..._--.-_ --. ❑ Distance to nearest lot line--"--------------------- --------'------------------------- Remodeling and/or repairing (describe):------------------------------------ ----- , -------------------------------------------------------- ------------•----- r' -------------------=--=--.-----=------------ ----------------------------------------------- :s ------------------------------------ --------------- ------------------------------------------------------------------- --- ill -- - e in - --cor - ai --- ui I hereby certify th have£prepared this application and that the work will be done in accordance wi#h San Joaquin County ordinances, State laws,�C'erules and regulations of the San Joaquin Local Health District. ., . �a [�' ?/fist ontrac+or� Si ned ................ --------------------- (Signed -------- 'i"tC""T.�.1�IK"sEFZ�'FCE----- ----- -- --- ------ Ttle _ 2915 E Miner Ave, ki0.---3841 __ i tie) - _ ( (Plot plan, showing size of lot, location of system in relay n to wells, building etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY pp 6` ---G1-" ---�— � APPLICATION ACCEPTED BY -------------------------------------- DATE---------1 - REVIEWED BY-------------------------------=------------- - .�� ----- ---------- DATE---•---------------------------------------------------- -- ------- BUILDINGPERMIT ISSUED----------------------------------------------------------t--`-------------------- DATE Alterations and/or recommendations:------ --------------------- ------------ ---------- -------------------------------------------------------------- - -------------------- -------- ------------------ F F .i FINAL INSPECTION BY:...- - ------ ---- --------------- - -= Date.. - � ------ t 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tla:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California • .. F.P.0 O. l 'a `v