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FOR OFFICE USE: ' i R )q - �Q }� • = = ---- ----------- Z1 -.- :.--- -7 '- -------- -----_ APPLICATION FOR SANITATION PERMIT Permit No. 7 Z ------------------------------------" -`-- -- ---- r (Complete in Duplicate) Date Issued -A//-�_ -------------------;___-.__ ---____--_____..-__.._._.._. This Permit Expires 1 Year From Date Issued s Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS ANQOCATIO ._&/��---- e✓ Q , P/ ;;. ,.. Owner's.Name A1117111-Ag ------------------------------------------ ------- ------------------------------------------- Phone--/q Address----- -------------•-----------------------------•-•- tontractor's Name-------- - --- ------ -------------•--------------------------------------------------------- ---------I------ Phone------------------------•-------... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms _;9- Number of baths A_ Lot size 191P;Ar1 ______________________________ , Water Supply: Public system ❑ Community system ❑ Private Zro"6epth to Water Table _9�4_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El l Previous Application Made: (If yes,dote--------------______) No p�. New Construction: Yes R201No ❑ FHA/VA: Yes ?Rd'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! p (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A Septic Tank: Distance from nearest well ___-_-__Dista cteW-from�foundation___� _.---_Material- �,/ No. of com artments_ f_ 0:F Liquid depth___-��__.______--Capacity_22i _-___. [J rI p - size- 1 / .01i Disposal Field; Distance from nearest well. v _ -_Distance from foundation._®---------Distance to nearest lo) line__---------- 'i Number of line -7 _____ __ Length of each line_ r - 9 a _ ---.Width of trench-19----------------------------- Type ------- ------ Type of filter material_ -? __ Depth of filter material__ _______.Total length -~_ Seepage Pit: Distance to nearest well-Apo_.......Distance fr m fondation__ ____-_.Distance to nearest lot line__. ______.- ®� Number of pits...._l-------------_Lining material__ _.-Size: Diameter._. p ref---- _i Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material------------------------------------- Size' ___---_--- ---_-_.____-_______Size' Diameter---------------- --------------------De th---------------------- - --- _ ------ --------------Liquid Capacity gals. Priv Distance from nearest well---------------.___ -----------------------------Distance from nearest building ❑ Distance to nearest lot t line ----------------------------------------- -------------------- -----------------------------------•----------------------- T Remodeling and/or repairing (descrij --- - s 1-------- ------------------------------ S I - } -------------------------------------------------------------- --- -- 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 i eg lations of the San Joaquin Local Health District. F __-�__._ ___ _ _________________Pnfo ________________ _________.-_____________._____ [signed}------------------ ----------- _ -----( Lor Contractor) - By:--------••----------------- .!s -- ---- -- Title --------------------------------------------------- -- - - -{ )-�--1�-'fes-----�- --------- -- ---- ,(Plot plan, showing size of lot, locatioWof sysfem in re! wells, buildings, etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY - - -------- G' - ----------------------------------- DATE =1- u� G' ---------------- -- - ----------- REVIEWED BY----------------------------------- =-- - - --------------- DATE------------------ BUILDINGPERMIT ISSUED----------------------------- --- ----------------------------------------------------------------------------------------- DATE--------•------------------------ ------ Alterations and/or erecomplendations:---------�-�`�--:�--._---`�z--�--`�-,-�-`%` �_��-� -------------- � v --------------- . .�- - -------- --- -L ��' •`- - '� b� G``Za— �� / / .S I.r - z— ,?-�r cam---- ;2- -------------------------- --------------------------- -- -------- -- - ---------- --------- -------------------------------------- -------------------- ----- - -------- --------- ,� i 7/ -- FfNAL INSPECTION BY:.-----'=2�-•- -- =-J- -G�-Y'-��.._--------- Date------------------------�-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300/West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California = ba Manteca,California Tracy,California F.a.co.