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FOR OFFICE USE: ------------ -- ------------- APPLICATION FOR SANITATION PERMIT Permit No. Z&d.2:0.. w (Complete in Duplicate) --�- - --��_.��-vE'#-- � � � { P P� } Date Issued -�,q3_-___ 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. This application is made in ticro7mpliarce with County Ordinance No. 549:`„ JOB ADDRESS AND �LLOCATION--`--- _V--y-�--SI___ =:"_"F L-t- - -----------,----------------- ----_.F---- Owner's Name---------- '�- }>�_n{.--------Marj.NT_N__&-- ----------------------------- -----y------ Phone------------------------------------ Address ------------- -------------------- AddressT t ..... '--------------- =-�- ------------------------------------ Contractor's Name �I� .__ ha-L I �►'- hone----------------------------------- Installation will serve: Residence�` Apartment House E] Commercial E] Trailer Court ❑ Me TIE] Other ❑ - -D---x----2Q-®------------------ Number of living units: __1.____ Number of bedrooms .3_ Number of baths _�.- Lot si'z'e -----/r � Water Supply: Public system ❑ Community system ❑ Private Z-"`6epth to Water Table _I._ ft. Character of soil to a depth of 3 feet: Sand WGravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay 0 Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date........ 1 No New Construction: Yes' No ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: —",�Nose tic tank or cess vol- �erm'iffed=if u61ic sewer is`available within 200-feet.)- 0 00-feet: { P P P f Distance n co r art nearest well __5 ____Dist e�from foundation-_.C_ --_--.---.Mater al--- /1�CR ----------------- Septic W Distance from n /1 p menfs------- --------Size_�/L_I.QX�---Liquid depth--- ---_--------Capacity_-f_ZVr�_-, , Disposal Fiefd: Distance from nearest well-----ST---Distance from foundation.10-----.----Distance to nearest lot lime---�----- ` Len th of each line___ _ - r [.r Number of lines,------------ - ------ - g ��-�------.........Width of trench- --��?------r-------------,,,�� Type of filter material---.. .- - ��--Depth of filter material___/T_______._Total length______/�-Q-------------------------- Seepage Pit: Distance to nearest welt---5_______ -.. _-_ i"sTance-from foundation_--- -- ---------- Is of nce to-nearest lot line----- -S___ .__._ #dumber of pits-1_---- ng ma ena -- --- - - ize: i ---- - ------- 0 Cesspool: Distance from nearest well------- -. --_Distance from foundation--------------------Lining material --.--..--------------------------- EJ _---` ------ ------❑ Size: Diameter--I-------------------- --------------Depth----------------------------------------------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well------------------------------- -----------Distance from nearest building--------.-._-.--.-.----__-._____._____-- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- --------------------- -------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------•------------------------ -------------------------------------------------------------I--------------------------------------------------------------------------------------------=---------------------------------------------------- --------------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+tIqWs, and rules pd regulationsdof the San Joaquin Local Health District. [Signed Z ---t - ------------------------------------3 {Owner and/or Contractor] .-__. -- - :. --- - `�''=�_CJ--------- - �- `{Title}---.-��/1�T=--=': ...._-..------�------�----- ----- ------------- ----------------- -------- ----- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a : (-n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.----I-' (_R.`--0------------ -------------- --- -------------------------------------- DATE----- - s-�r------------- REVIEWEDBY-----------------------------------s---------------------------- ------------ ------- -------------------------------------- DATE----- -----------------..----------------------------------- BUILDINGPERMIT ISSUED--------------3-----------------------------------------------------•----------------------------------- DATE----- ------------------------ ------------------------------ Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------=-------------- -------------------------------------- 3 ------------------•----------------------------------------------- ------------------------------------------------.------------------------------------------------------•---------------------------------------------- ---------------------------------------- ----- ---------------------------------------------------- ---------------------------------------- V--------.---------- --`- -•--------------- -----•----------------------------- ---------- ------------------------------------ -- ---- --- Date-- ------'-�- ------- FINAL INSPECTION BY � 'r D. •� - - - - -1 - --�- -- � ---- -- �' ----------- ----- - ----------- ' - --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. f 1S