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t-UK Ul-HU USt: ----------------- -------------------=--------- --------- APPLICATION FOR SANITATION PERMIT Permit No. -Ao",P. ----------- ----------------------------------- (Complete in Qliplica+e) t --- ----I----- -- This Permit Expires 1 Year From Dat"Ossued Date Issued .:. ,� DS3 -lav ca Application is hereby made to the San Joaquin Local Health District for a perm to construct and install the vlork herein descri ed. This application is made in compliance with Count Ordinance Na. 549- ;�,J� �_/ y- �.�c, /� �� 5 0-Al- f_t•v,v rely � A(I ��[[// J///// r� P ul JOB ADDRESS AND LOCATION___ �+ cel ------------------ --------- �' - � Owner's Name ---M... C-•-y-----_- � _.. ------------'-----' ------------------------- ------------ P hone-•--'-----•---'-------------------- ikf Address -0................. �Q -... Name._ ____,. 1 1 -�?,(/c,-------------- Contractor's �' �ALp ___Installation will serve: Residence arf hent House Commercial� ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: Numbe r of bedrooms-- Number of baths f----- Lot size __ _ o Water Supply: Public system E] Community system ElPrivate ,Depth to Water Table _ ._dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy La"i. ❑ Clay Loam ❑ Clay ❑ Adobelardpan ❑ Previous Application Made: (If yes,,date-------------- ----_I No ❑ New Construction: Yes ❑ NoClit— FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' ` k . a (No septic tank or cesspool permitted if public sewer is available within 200 feet) _ ` Sept' pW '+ .:,00'"'x' ."'"`'No,-o+-compartn�ents� >Q0_`Siz � "�'F)�"�31',quid ®th t.-�� j Ca acit _�_��_� e ti Tank: Distance from nearest w Distafrom fon tion__ _ Mate 'al._. _ _ I P Y Disposal Field: Distance from nearest we! Distance from fa ndation__- -" � I. .Distance to nearest lot Iine_Ain- Number of lines _ -_- ___ Length of each line --- - 9 ed--"----/-. Width of trench�_.h_C!/-- --�--------. . /9-----------.Total length-----------. Q� Type of filter materi ` Depth of filter maternal_._ y � � 1 �. Seep ge Pit: Distance to nearest well_ +1?fl- Distance from foundation______ _ - p NZ Number of its-_ g - Size: D a eters �i_toD nearest II "� I p Linin mater;al_ @ Cesspool: Distance from nearest well________________Distance fro foundation.l I �-'LEning material---------------' ❑ S;ze: Diameter " Depth" ------------ -- -Liquid Ca acit -------------------------$gals. Privy: Distance from nearest well — �, Distanc from`-neares`t bwldin % Lf_ - - -------------- - ❑ Distance to nearest lot line--------' --------- `x l 9 -- - ----------------- -- -------------------- -------- Remodeling and/or repairing (desk bej:�_-_`. .•-__-""" _ ,,,; ,�, �-�r �r -=- -- - -- 1 ---L' _- ------------It- "----- ------ ------- - �.- f ! 1 --------------------------------------- --- ___ ________ _____ _ ____-_____ -____________.___________-_______________-_-_______________ ___------------- ---------_------ _______________________...-___-_--------------- I hereby certify that I have prepared this application`and that+he work will bepdone in accordance with San Joaquin County ordinarices�State laws, rules and regulations�ofxt.ie San Joaquin Local Health District. (Signed)-------------- -�, = '--------- " w F BEpTIC T €- 1 ---- -----� or Contractor) B '293" _, AtNK ��1�G!~ 1.1 Y E Nfin"Ave,, ®:" = -- -------- (Title)---------- - ------------- -- ----------- - (Plot plan., showing size.,of;ao+,; oda on..o�,,sysfern.in.,.relation- wells,,buildings,r c.,xcan,be placed�on reverse side). . ( FQR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_ DATE-- REVIEWED BYF' --------- - ------ ------------------------------------------------ DATE - ---- --'- - -- - ----------------------------------------------------------- -' ---' BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE------------------------ ------------------------------ -- Alterations and/or recommendations:-..__----_------------------ --------------------------------- ------------------ -- ------ -------------------------------------------------------------- ------- ------ =a=:--------------- - - ---------------------------------------- ------- ------- ------------'-------- -------------- FINAL INSPECTION Date---- -_. _' .� . SAN JOAQUIN LOCAL HEALTH DISTRICT t Y ' 1401 E.Hazelton Ave. li� 300 West Oak Street 124 Sycamore Street 0205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California r.P.c o.