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FOROFFICE USE: ---------------------------------------------------- -_--__ ----------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ......5.... --------------------------------------------------------- (Complete in Duplicate) -_- .mid _ - Wf Date Issued ..-21 -� -------------------------------��-�--� .� � This Permit Ex fires 1 Ysar From Date Issue"d� "" � � ''"y" 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 compliance with County Ordinance No. 549. ROAD i t a j - JOB ADDRESS AND LOCATION----S0_U-1-I'------faJd ----- -- '-------`�2---7' '-`-'------- ' -7 ----f5�_1YA179hvi I Owner's Name-----/(e--r7 �1----------is=-------- B-le---ck-------------------------------------------------------------- - Phone -10_-'-J.11-11r5_ y Address---39.16-5-------le_�--------- ^ ------ ------------ Contractor's "-----eContractor's Name---- 6 L` . Phone---------- -------------------------- i ---••--- ' e eJ Q tib '► `' Installation will serve: Residence Io ApartmentHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.._ Number of bedrooms _ `a .___AC g ___ _�"._ Number of baths _�.. .. � � -_ Lot S1Ze ----��-p-�-6-�-----: � Water Supply: Public system ElCommunity system ❑ , Private tDepth to Water Table -------- ft. A, Character ofsoil to a depot of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ i Previous Application Made: (If yes,date____________________] No (C New Construction: Yes 14 No ❑ FHA/VA: Yes ❑ No ❑ Q) TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic'tank or°cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance-from,nearest well_._.iQ_____Distance from foundation--.J--0_...____.Material__..____ __________________ NI , ® ,-- No: of compartments-_ ------------ .___ . _____Liquid depth----&_ 4- ------Capacity-43-av...5_,A xji Disposal Field: Distance from nearest well_._.,..5_......Distance from foundation___..I1____.__.Distance to nearest lot line___��------ ' t / ! j > Number 'of'lines___.._______�---------------Length of each line--------- ______________Width of french----------- X-___--___----___ Type of filter material c_ ezkDepth of filter material------ length------ 6C1_..--_________________ I Seepage Pit::. Distance to nearest welll!_C1_ _Distance from foundation___ _. Distance to nearest lot line-/,;7-- Number of pits... ---_Lining material [."Ie: Diameter._ 7�__�_j DePfh__..A-2V- V Cesspool: Distance from nearest well�..'Distance from foundation.-- -lining material-...____.____________________________ ❑ ; Size: Diameter---- - --------------- ----- -----Depth-------------------- :----------Liquid Capacity----------------------------gals, Privy: i t. Distance from nearest well__________________________ -------___ __ �Disfance from nearest building------------------ f 0 V Distance to nearest lot line-----ft) -- ------•--------------------------------------------------------------------------------------------- kRemodeling a nd%or repairing (describe):------ - --- -----------�-G,---e -----------------------------------------------------------... -•-------•------------- ------ -------------------------- - - ----------------------------------------------- -------- I hereby certify that I have prepared this.application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �fl (Signed)------ 7i ------------------------------------- --------.(Owner and/or Contractor) - Plof Ian., showing. esof .-�--•---••-•-•---- -- - - - - - --- - - - Title + - F. _ �,,,( Yp meg.; lot, location of system relation to well b�uilld�ings, e�tc.., can be placeActn reverse.side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 14 C4� - ,L�<�. -------------------------- DATE---------------- �1- '� REVIEWED BY------------------------------------------------------ - ------------------ -------------------------------------- DATE-------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------ --------------------------------------- Alterations and/or recommendations:------ ---------------------------------------------------------------------------------------------------------------------------- --------- --••------------ ---------------------------- -------- --------------------------- ---------------------------------------------------------------------- ------------------------------------------------ ------------------------------- FINALINSPECTION BY:.-- --- --- ----------------------- • ------- Date---------------------- ------.---- ---------- - ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California