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FOR OFFICE USE: 4 ------------=------- - =�_-------------------------------- DD -._---.-----_-------------_.----.------_.--_.------- APPLICATION FOR SANITATION PERMIT Permit No. IYJ6_�_- -----------------•-•------------------------------------ (Complefe In Duplicate) Date Issued- � ._...._ This Permit Expires 1 Year From Date Issued Application,is_hereby made to the San Joaquin Local Health District for a permit to construct d irLstall the work h rein described. This-a.p lication is made-incompliance with County Ordinance No. 549. ' `(?O- l JOB ADDRESS AND CATION --- Owner /f, Owner's Name U �] 11G� � � ' "'- Phone-------------------------------•---- r / - F Address3 Q.�s.?------------------------------------------------------•------•--------------------------------- Contractor s Name. - D ��1---- -- )-e -------------------- ----- Phone----------------- --------------------------- ----------------------------------- -------...------- Installation will serve: Residende.ffj--A`partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ --_-_.Number of bedrooms--_ Number of bathsc,-_J_�LLot size ,r 1� Water Supply: Public system El 'Community system [:] e � ep PrivatR th to Water Table&--___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand oam ❑ Clay Loam ❑ Cla Adobe ardpan ❑ Previous Application Made: (If yes,date...___..._,___.____1 No New Construction: Yes ®/1Vo ❑ ❑FHA/VA: Yes TYPE OANSTALLATION AND SPECIFICATIONS: {No sep}ic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well__.-------Distance from foundation____.______.Material__ _d------------------------ __"-.__.._- * p --------- T-u�---- Liquid depth------ -------Capacity----� -------- No. of com artments___._.��__ Size___.�__� ��____� Disposal F' Distance from near well_ .-----._.Distance from foundation----f �._ Distance to nearest lot Number rof lines _._e�� _ _____________Length of each line______2471__ ---- of trench------- ------- Type of filter mate l____- ---- __._.._Depth of filter meenaE-----_ " _"--_ ._".-Total length_"_-_-� __---______-___:_-"_: Seepag i k Distance to nearest welL._/Qv--- ---- cfrfoundation n - ( ian e to nearest l r->� ----- Number of p'ts.....�----------Lining maaferial ) ASize: Diameter__ sfDep � Cesspool: ` Distance from nearest wel€-----------------Distance from foundation....................Lining material_:_.___f__ ---------------- El fSize: Diameter---- ___------ ------ ---Depth------------ .....Liquid Ca acitY -------------------9als. Privy: Distance from nearest well___-----___--------------- ---------------------Distance from nearest building-------- * Distance to nearestllo+ Ione-------------------------`--------- --------------------------------------------=-------------------------------------------------------------- Remodeling and/or repairing (describe):-- -------------- ate/ f --•----------------------------------------- ----= t ------------- ------------------------------------ ----------------------------------------------------------------------------------------------------•---------------------------------------------------------------- i r I hereby certify that I have prepared"this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules.. d regulations of the San Joaquin Local Health District. Si ned sL1 ---`I}--�°------------------------------------ ---------------------------------► (Owner and/or Contractor) , . . (Signed) - :' - / Plot fan, showin of to J - Title C1LC1�{/_ ..I__- Y � r.�-�= ----------------- - --..._�.{ ) ( p g t, location of system in relation to wells, buildings, 11 etc., can be placed on reverse side. r 'FOR DEPARTMENT USE ONLY , t APPLICATION ACCEPTED BY----------------- -------------------------------------- --------!---,- ---- - C/ PATE_ 1�-- --(�------��--5 ------------- REVIEWEDBY--------------------------------------------- -----------L------ - --------- --------- --------- ------ DATE-_•------- a. --------------------------------------- BUILDING PERMIT ISSUED: - ---/----------------- -- DATE -- Alterations and/or recommendations:---------- -------------------------------------------------------------------------------------------------•-------------------.-----••-----------------------------•---•----------------------------------------------------------- ----- --- -- ------ - --------------- -------------------------------------------------------------------------------------------------- --------------- - (J1 FINAL INSPECTION BY:.'---.---.- -- � Date ._ ._. - S. N JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Haxellon Ave. 300 West 0.4treet > Mr F r 124 Sycamore,Slreetg' 205 West 9th Street Stockton,California Lodi,California y Manteca,California Tracy,California s / F.P.c o.