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FOR OFFICE USE: ---- ---------------- -- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) t - -3-�.a ----------------- - -- _ ..-- . _ ----- . This Permit Expires 1 Year From Date Issued Date Issued -__------- _.-.---- permit to constr ct and install the work herein described. Application is hereby made to the San Joaquin Local Health Distract fora p This application`is made in compliance with County Ordinance No. 549. 64 1 JOB ADDRESS A LOCAT N-- ��"J '�`" -'--------- ----••------•---------------------------------------------- Q-R� �u2�C ,� ----- Phone-. �=.. �f.'� Owners Name----- . -- z ._._..... .................................. --- ------- --------------- .17 Address-----•---------_------ ----- .1:. �-. --- --- -- --Z 4` ...-- - ---��---------------------------•-----------------p--`---` t j �[ Q.,.f� � Contractor's Name-- -------I—— -- --�------------- C14 •Urs Phone...- Installation will serve: ResidenceApartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: ---�__ Number of bedrooms Number of baths J---- Lot size _-- ,.r-.-_--7l---._�- ©_--_-__--.---_ Water Supply: Public system E] Community system El Private Depth to Water Table .6 oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam El Clay E] Adobe E--Hardpan ❑ Previous Application Made: (If yes,date--------------_----I No El New Construction: Yes E] No �HA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Ta :, Distance from nearest well-----------------Distance from foundation--------------------Material------------------_----._--__-----..---_-----. No.sof compartments--------------------------Size---------------------------------Liquid depth--------------------------Capacity...--- -- ------------- r ni D osK I Distance from near st well. Distance from found tion--lC/.--_ ---.Distance to nearestlot�lot IV -_/� Number of lines-- . Length of each line- : Width of trench.-�C.t_'7-`--a�-_--- � �[r�7-, i--- 9 Q Type of filter materiap(df3 '(.e_ Depth of filter material___._- -_____.Total length------------------------- _--- Seepage Pit: Distance to nearest well----------------t----Distance from foundation------------------- Distance to nearest lot line----------------- C • ElNumber of pits--------------------=Lining.material-----------------------Size; Diameter-----------------------Depth--------------------------------- W Cq Cesspool: Distance from nearest,well-----------------Distance from foundation_____.--------------Lining material------------------------------------ � ❑ Size: Diameter--------------- ---------.Depth----------------------------------------------------Liquid Capacity- ------------------------..gals. Privy: Distance from nearest well------------------------------------------------- from nearest building_ ...---------------..-_----_. ❑ Distance to nearest lot,line--- ------------------------------------ --------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe}---------------- ------------ ------------ --- ---------------------- ------------------------------------------------------------ ---- - ------- - --- ------ 4-"Ic - - ___ - F r�. -�------------------------------------- --- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Jqaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed)-j/7-0---- ----�� --- - ------ -- ------------•----------------. -LC4*Pojo0u0" Contractor) $y:------=----------------- ' - --_-------_--- --------------------------------------------- - -- (Tatle)- = �... (Plot plan, showing size of lot, location of system in relation to wells, ildings, etc., be placed on reverse side). FOR DEPARTMENT USE ONLY y2 r APPLICATIONCC T D BY ----- ------------ ---------------------------------------- DATE----- -------------------------- REVIEWED BY--- `` - - DATE-------- 3----�--- --`5------ BUILDINGPERMIT-ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations: -- ----------------------- ----------- ----------------------------------------------------- --------•-•-------------------•-•-•------ -----------•--- -------------------------------------------- --------------------------------------------------- --------------------•----------------- ----------------------------•-------------------------------------------------------- --------------------- ------------------------------------•------------ - --------------------- -------------------- ------------------------------------------- ------------------------------------------------------------ ------------- --- -- --- -----------------------------------------•---- - ----------------------------------------- ------------------------------------------------ ----------------------------------------------------- FINAL INSPECTION BY:.. - ... " ell---- ---------- Date (� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.