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:-_ -- -------------- ------ -`- -- ---------------------------------:_-_.__ .__ _ APPLICATION FOR SANITATION PERMIT Permit No. .cd._IF� -- - ------- --"---------- ------------ ------ I (Complete in Duplicate) --------------------- •----- - Date Issued This Permit Ex fres 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. This application is made in compliance with CountyOrdinance No.`549. - J' L.�� 60"se. o n �r-i yhf a�end JOB ADDRESS AND LOCATION__.--- S_` } D FsOed rvad, �i}l� nhr.C�cP� ------------ ---- Owner's Name COY--ri!k_ ]n1�'.-----------r--------- Phone Address-----------•-----: . --- Contractor's Name-------y-!,_t1�..*p _YY_1__ _: T?� I �, 3 ------------------•----•------------------- Phone__ '.&.& Installation will serve:' Residence *"'Apa'rtme44,louse I] Commercial ❑ Trailer Court-61 Motel ❑ Other ❑ Number of living units: -------- Number of �- bedroomNumber: f bbaths . _ Lot size Water Supply: Public system EF Community system ❑ Private • Depth to Water TableV'____ ft. Character of soil to a depth of'3 feet: Sand ❑ 'Gravel�❑� Sandy Loam ❑ Clay Loam ❑ 4CIay ❑ Adobe 0' Hardpan ❑ Previous Application Made: (If yes,date.._.v__U___..___ ) Nod❑ New Construction"" Yes No I - '= � - --- •-• � ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF IISJALLATiON AND SPECIFICATIONS: (No sepfic.tank or cesspool permitted if public sewer is available w hin 200 feet.) ~ Septic Tank: . , Distance from nearest well__-_f-_-.______-Distance4from foundation____..___._- f ❑EXE si No. of compartments------ -------�----------Size--------_#------------------ ---LigrFi I-depth---- Capacity Dis osal Field1 + p Distance-from nearest w.efl____.�Q _Distance from foundation___:?- �------Distance to nearest lot line___la_�--- Number of lines---- ------ ' ..> rF (p J!. . ', Lengt of each fine--------,�. --_-Width of trench...... ---- * Type of filter material; - __-Depth oft filter material____---I-e Total length__------.. 5--- -- Seepage Pit: Distance topro pearest weft- � -Distar�e:from foundation_: r Distance to nearest lot NuPnber'of omits\'-------l__-`-4L'-iniri materal--- l�d. Size: Diame r---� �_rl---p <-^ -- ----- De th-- �2_� ------- Cesspoof }istence-Fran- erre ' _ - - -------------- -- "stenze-from,founda#ion---:---__�-�-.,.Liningrmaterial=:_:----=-:------ -- ---------- Size: Diameter -'Depth M--------------------------"- --------------Liquid Capacity--------- gals. "� _�- _ _Distance f'ro riea est building Privy: Distance from nearest weR___�_�'.-�_.--_____-___ Distance to nearest lot line.___-_____________---------------_ _.y:. _. _ --------- Remodelingand/orae airin descri a :---- - �---- ------------- -------------------------------------------- ----------- ------------ ---------- --------- -- ------ -------------------------------- --------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r .---� — (Signed)------CGI-`-/�`'-- ----- -- -r�� - ----- --- J'2S__ ...� ------------------------------ ------------------ caner and/or Contras -------------------- -(Title------ 1 -• I By:---------- -------- o for (Plot plan, showing size of lot ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y __ REVIEWED BY - ---------------------------------------------- e ---------- DATE.----------� -- --- - ------------------ -- BUILDING PERMIT ISSUED------------- ----------------- _- - ----- -- ------ DATE-------- ------------- ------------- ------------------------ -- -------------------- ------ DATE Alterations and/or recommendations:- 4 -------- ------ ----------------- -------------- ------------ FINAL INSPECTION �BY:-�- . _ ' � � p •---- ------ Date---------- - ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:ellon Ave. ! � 300 West Oak Street 124 Sycamore Street 205 Wes!9th Street Stockton,California Lodi,California Manteca,California Tracy,California .•may F.P.tI O.