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FOR OFF(gE'`�%�sE - = = - ---- Permit No. � 21A. - N APPLICATION''FOR�SANITATION PERMIT � �- --- r------ ------ ---- ------ ----- ------------------------- (Complete in Duplicate) Date Issued Win'-��" - YThis 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 her described. PP This application is made in compliance with County Ordinance �No, 549. ``+4 "1� n , �_{ JOB ADDRESS D"LOCATION1-��2y._ ,•� Q ,__ _> Er �_f2� -- -- ��C " ', Owner's Name----" s t -! . . - �5C -1.._ . 5 r 7 7------------------------------------------------------ � Address-----�----•---•--------��_-:=�'`-------•--- - �---••--"'..------•----------- t Contractor's NameFL�_ Ry� �LjJ �-ei =--------- ------------------------------------------------- Phone Installation will serve: Residence M�partment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other E] 9 Number of living units:_" Number of bedrooms,____ Number of baths < Lot size ___1- r___ - -!' -- --------•----------- Water Supply: Public system ❑ Community systeML ❑� Private �epth to Water Table®ft. Character of soil to a depf6of 3 feet: S 6rd ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -Hardpan ❑. I Previous Application Made �fyes,date_..! :._---""-----�;1 No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ _No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cess$ool permitted if public sewer is available within 200 feet.) i Se Tank Distance from nearest All----------------- fro m foundation____________________Material_____..._______.________"_______________d 4 f � Li quid de th_____________________ ___Ca Capacity `"" IJ! )o. of comm rtments..1��--------f------ -- Size------------------------------- q l� P Y ^tea Dis II Distance- ♦ of .nearest iLell._lP_Q-_Distance from foundation___ ________.Distance to nearest lot line____,l�© umber of Ines Length of each line__" - ---�-F--Width of trench__________,_ Type of filter material _. --. ..bale Depth of filter material------1.6�_-- _..Total length --"" �-- ----�-r✓ , � i :: ____..___.Distance to nearest lot lin`.__ __e&* Seepage Pit: Distance to#nearest welL..�.��.___ Distance from foundation__�2 ` 12 Number of pits. ____.___-Lining material__ Q- Size: Diameter__. " _ De tn__ _ f� J�- -- P Z-------------------- Number ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation_...___.____---____.Lining material___.----------------------------- Cesspool: _...._.----.- - """gals. Liquid capacity---------------------------- Size: Diameter--- Depth-------------- ------ ---------------------------- 9 Rr..ivy.) Distance from neo st well-------_----------_________________------------Distance from nearest building---._..______._---__.__________.____.__ Distance to nearestdot line e------- ----- -----•-------- ------------------------------------- Remodelin and/or re airin describe `` " "'1 9 P 9 ------------- - ---� �---- -fa--- ----- .............. > ��y ----------------- -- - -- --------------------------------------------------- ---------------------------------=_-_--- _. -•-------- ------------------------------ ----------------------------------------------------- ------- l I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courity� ordinances, State laws, rules and regulations of the San J quin Localea lth'District. /. _-- r eFContractorj {Signed)-------------- --&P ------------- ------------- . 1// - --- /(V rfc -rAN s with p Title By'29 �"E:filer-Ave:'� p{� 3�9-k-------- { ) (Plot plan, showing-sizgofot, location of system in relatio to wells, buildin s, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY DATE �` '2 ------ ---------- 1 APPLICATION ACCEPTED BY ---------------------- -- -------------------------------------- - REVIEWED BY---- --------------"-------- DATE - ------------------ BUILDINGPERMIT ISSUED-----------I- -------------------------- -------- ------------------ DATE------------------------------------------------------------- Alterations and/or recommendation3:------ ----------- ----- -----------•---•----------------------------------------------------------- --------------------------------1'---------------- -------- ----------------------------------------------------- ----------------------------- ---------------------------------------•-------- / - ------------------------------------------------------------------------------------------------------ - FINAL INSPECTION 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 F.P.CC.