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------------------------------------- ------------- - APPLICATION FOR SANITATION PERMITR . —.y. Permit No. . d�c� -- -- -- -- ------------ ----------- ----- - (Complete in Duplicate) I x --- -- -- This Permit Ex fires ] Year From Date Issued '� bate Issued f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in complia; ce with County Ordinance No 549./' herein described, JOB ADDRESS AND L_OCATIPfN}------/ � L p ---------E------ F----- c, < ` /+_ Owner's Name----_-__-___ ------- t 1_"_Gq Al) -- Address -------•• _ '------ Phone---- Confiractor's Name------ /! � _ �1TCf I ------ Installation will serve: Residence -- -- --- - Phone------=-------------- J ❑impartment House ❑ Commercials ❑ Trailer Court Q, Motel ❑ Other ❑i Number of living units: -!..__ °Number of bedrooms-3---- �' Water Supply: Public system Number of 13afhs Lot size _ i Y ❑ Community system ❑ Private '` Character of soil to a depth of 3 feet: Sand ®Depth}to Wat fab'i i ft 4� ---- " P I Gravel ❑ Sandy_Loam ❑ Qlay-Loam[] Clay-Previous Application Made: {If yes,dpie____ �Y Y'❑. Adobe ❑ �rHe'rdpan ❑ 1 No �' New Construction: Yes 1 I TYPE OF INSTALLATION AND SPECIFICATIONS: NO FHA/VA: Yes ❑ No 0 " �-(No-septic-tank-or cesspool.•permitted 'if-public-sewer is-available within=200 feet:} Septic T nk: Distance from'neearest well_--�. - ___--Distance from foundation------ No. of cam ac r�ntsi. -- - -� /.( Matar'al-._- QI1CJi l_�L �- P Size-� �®- -_` _ 1 __ - Liquid de th,_ Dis osal Field: - z-- � --------Capacity__]--__--_--v p Distance from nearest well_ �W----Distance from foundation--.--_�_ _ Distance to nearest lot line----- ----------- �� Number of lines -= _______------Length of each line-_ _ i___ U` ----------- Type of trench_-____Z�1.�1_--_____ Type of filter ma#erial_ � C �,_ Depth r----- .� of filter material-.-_---_1'7-___''tTofal length------- Seepagefes 0--- V+ Pit: rDistance to nearest well f'l-- "' " � ----- -�---------------- ------- Distance from foundation------------------ Distance to nearest lot line..-----.----- ❑ Number of its '.-f --------Lining material_ ------------- Size: Diameter-----=---------------Depfh-- ---------- ......... T Cesspool: Distance from nearest well-----------------Distance from foundation___________________,Lining material_-__..____.__ ❑ Size: Diameter--- t --------Depth----- ----.. -- - ..... -- Liquid Capacity. Privy: Distance,from nearest well- ---__-- gals. N El Distance to nearest _lot line-'.- ----`-----Distance from 'nearest building------------- --- l _ -----------r-------I..------------------------------------------------------------------------ Remodeling ----- -------- -•---•---'------- ----------Remodeling and/or repairing (describe)------- -------_-_ _ ----- -------------------1'-4.4 'vel •------------- - 3! ------------- ---------". ---------------------------- - -•--------------------------------------------------------- ------------------------•-------------------- ---------•----•------------•-------------- ' - •-- -e ---------------------•---•------------------------------------- I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -------- ------ - 1 ------(Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ._ f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...-.__.:_-- _ __ _ // REVIEWED BY r s -------------------- DATE ^l C BUILDING PERMIT ISSUED - DATE------------------------------- Alterations and/or recommendations: -_F ----a- ---- DATE----------------------- -------------------------•---------------------------------------•-------- � _ naw.._. ova , s - _--__._ -- f ........................... ---------- ---- ------- --------------------------------- FINAL INSPECTI - /l Date f SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street r Stockton,ealifornia Lodi,California 205 West 9th Street ;i Manteca,California Tracy,California � r p