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------------ ----------;�-- - --------- ------ --- FOR OFFICE USE:: A LICATION FOR SANITATION PERMIT Permit No. 1 . ----------------------- -------------------------------- -- --------------------------------------------- ------- (Complete in-Duplicate) -7 ------------------- --------------------------------- - This Permit Expires 1 Year From Date IssuedDate Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application.is.made in-compliance. with County Ordinance No. 549. &�LZ'- Awoq,t 4-16 12- 4 JOB ADDRESS IND LOCATION_�_& _,__j4 __ /Vo XZ::... �5_ -�_ " -------------_-- �G_ 16 7) A C Own - - ------- Phon P11 ------- ------------------------------------------------------- --------------------------------- Address-------------- T&A.0y---—-------- --t------------------------ ----------------------------------- Contractor's Name----FF--- ----saja----------------------------------------------- ------- Phone---- Installation will serve: 'Residence [] Apartment House E] Commercial [I trailer'-q-ourt D Motel El Other Number of living units: -------- Number of bedrooms -------- Number of baths --- Lot size ____________________________ Water Supply: Public system [3 Community system E] Private %, Depth to Wafer Table.10_ ft. Character of soil to a depth of 3 feet: ' Sand E] . Gravel'[] Sandy Loam E] Clay Loam Clay E] Adobe E] Hardpan 0 Previous Application Made: (If yes,dote----------- --------I No 1Z New Construction: Yes No [I FHA/VA: Yes M No) TYPE OF INSTALLATION AND SPECIFICATIONS: in ..{No septic tank or cesspool permitpublic if ic seweris available-with200 feet.) Septic Tank: Distance from nearest 7111- ------Distance from foundation-,/-------------- - -- - --------k No. of compartments__ _1_-�7---------------Size__S__ ------------- ---Liquid depth-!;_ -------------Capacity I '90 ;-A :2_,e Disposal Field: Distance from nearest welLY, Distance from four;6fion---------------------Distance to nearest lot line....-- Number of lines SM. I . .........Width of trench.___.:�7 DQ ------- ---Z6 C Length of each line-_ --------------- T I--- -Total length----5 0 4',,Fr-------------- Ii Type or filter material -- -----Depth of filter materia Seepage Pit: Distance to nearest well-- -------------._.-__Distance from foundation------- -------Distance to nearest lot line____._______..._ Number of pits------------------------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_._.._._._______---.----------._...._ 0 Size: Diameter-------------- ----- ---- -Depth---------:--------f----------------------------------Liquid Capacity------------- --- gals. Privy: Distance from nearest well__________________ _ ______ ______ ____. -Distance from nearest building_____...______._ -_____ ___--- ❑ Distance uilding----------------------------------------- Distanceto nearest lot line-- -------- --------------------------------- ------------------•----------- -------------------------------------------------------------- Remodeling gd/or rep iring ----- - ------- ------ ------- 4' C_/ ------------- ---------------- - ---------------------------------------------- -------------------- ------------ ----------------------------------------------------------------------------------------------------_--------r--------------------------------------------_------------------------------------------------ ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------_ -_ - -_ I hereby certify fhaf�l ave prepared this application and that he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatt V ,n s of the San Joa Local Health Dis * (Signed)------------------------ ------------------------ -- - ---- ' - - ------- ----- ---------- ------------- -a - - _(Ow-n-- e r and/or Contractor ) By:------ --- ------------- - - -- (Title - _j -- -- - PtufOl —showi6c"siz—f of-system in edlati6fft �ifigs— -fc., can-V -on reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED)3, —_------------------------- : --- DATE_. ----------------- -- REVIEWEDBY---------- .... C� --•------------------------------------------------------- - ------------------ DATE-- .----------------*-------------------I----I------I—---- BUILDING PERMIT ISSU --- ---------------- DATE----------------------I--------------------------------------- Alterationsand/or recommendations----------------------- ------ ----------------------------------------------------------------------------------------------------------------------------- ------------ ---------------------------- --------------------------Z--------------------------------------------------------------------------------------- ----------- ------------------ ------------------------- ----------I------------------------ ------------------------------------------- ------------- -------------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------- --------------------------- ------------------------------------------- --------------------------------------------------------------------- ------------ -------- - ------ ---------------------- ............ - ------------------------/-------------------------------------------------------------- ------- ------------------ -7 FINAL INSPECTION ---- -- -- ----- -- - -------- Date---------------------- .. ----- ---------------------------- 'JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Nozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California = Manteca, California Manteca,California