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J FOIA OFFICE USE: x ------------ ' / 3� .,� a APPLICATION FOR SANITATION PERMIT Permit No. ..1.. -_-....._.Z -.. cf 2e l -------------------------------------------------------- (Complete in Duplicate) �G - --- This Permit Expires 1 Year From Date Issued Date Issued ___ ----____-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS A OCATION.- I- .IO�Q��77�l -- en---------------------------------------- -f----------------- t g Owner's Name-- a__1-2e_4---- �� 4 t!l.$ -------- --- ---------------------- Phone��r_ - ,7- Addres s__51.ID-- -P'`-`', �. --- ------ ----------- -- ----------------------- t Contractors Name- `---�Lq_ C��-------------------------- Phone_4/41! 41N.Ri-T -- Installation will serve: Residence ❑ Apar Ment House ❑ Commercial Trailer outzeofel L] Other Number of living units: I.. Number of bedrooms ________ Number of Vat s -------- Lot size ___________________________Ito--- � .�_,C} � Water Supply: Public system M_--community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date..............._--I No ❑ New Construction: Yes J20"No ❑ FHA/VA: Yes ❑ No .TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Q Material Septic Tank: Distance from nearest well _ D Distan e fr fou ation__ __ No. of compartments_----------------Size �-X_ ____Liquid depth___,Yb---4.........Capacity__ Q � P `:it Disposal Field: Distance from nearest well_Ml;EY4r_Distance from founds ion___ .....Distance to nearest lot ine___._� Number of lines_y__ _._._ __ ._ _�___Length of each line �_�____ -----_ Width of trench-�l ��. r fr'I Type of filter mater'ito �'G1C�-__.Depth of filter material ______._-__Total length________ ___________� Distance rom foundation___ Seepage Pit: Distance to neare//��t well__N_ ___.._. _ _ �C�.._____.Di t ��e to nearest lot lie__.-_-_�_� Number of pits._�[.,______._.______Lining ma ---------Size: Diameter____ __ Deptn__ _�_____--__ _ Cesspool: Distance from nearest well______________Distance from foundation---____---_---- __..Lining material-------._____.___.__.____________.__. ❑ Size: Diameter---- ----- Depth-------------------------- ' .Liquid Capacity----------------------------gals. Privy: Distance from nearest well------______----------_--------_-------------Distance from nearest building__________._..._________________.____..._. ❑ Distance to nearest lot line--------- -------------- ------ ------------------------------------------------------------------------------------------------ Remodeling and/or repairing.(describe):----------------------------------------------------------------- i--------------------------------- ------ ----------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - -------------------------- I ------ ----------- ---- I hereby certify that h�-�ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aRAles and regulations of the San Joaquin Local Health District. r, r1vt Contractor) (Signed)---------g�pTC�.-rA`IK-SM:RV1G=.------------------------------------- - ----- ------ 13 29366,MlnerAve,- H0. r 13`fa Title .................. Y - --- --- ---- I ) (Piot plan, showing size of lot, location of system in relation to Ifs, buildings, et ., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y-- ha.� --------------- -- DATE---- Q----��--------------------------- ------------------------------------- REVIEWED BY--------------------- ------------- - ------- ----- ----------------- ----------------------------------------- ------------- DATE---------------- - ----------------------------------------- BUILDING PERMIT ISSUED-------------- -- -- ------- ----_--:----- DATE --------- ----------'---------------- ...��... . - ... ------------ Alterations and or re mmendations:._..__ �c_ Q .._.____ ^- _ / --------- ' - �-a _� -----------------I-- ` ` c�4--. 8�3d�= �tuac� � •------ - 'a- ------------ ------------- ---------- ---------- - ---- -- - - -- ----- -- - - - - ' °-- 1¢--�------------- ------'-- -------- --�----...�----tom --------------------------------- ------------ -------------------------------- ----------------I---------------- �� ------- Sj FINAL INSPECTION BY:..--- ------------ - - - -- - ---- - ---- - -- - -- ---------------------- SAN - - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Natation Ave 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.C C.