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FOR OFFICE USE. ------------------------------ ------------------------ APPLICATION FOR SANITATION -PERMIT Permit No. .- ®_., ___�� -------------------------- ------- ----- --- (Complete in Duplicate] This Permit Expires 1 Year From Date Issued Date Issued 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. JOB ADDRESS AND LOC ION, 'll - -------+ ` ---------- -,Y* ------------------------------------------------------------ i ] 3 Owners Name -------:- ':_ _ �•�__x _�u� € �� d� Phone y Address------------............----•-------------- T------- j f & *t� •- Contractor's Name------ -----------------------=-•---•----------------------�----------------------- ---------------------•-----------------------•-------- hong'�_, .._ .-• ---r -- Installation will serve: `Residence partment Hou e ❑ Commer`cial ❑ Trailer Court ❑ Motel ❑\Other ❑ Number of living units: ),.._ Number of bedrooms -- Number of baths 2- _ Lot size --------- i � r Water Supply: Public system E] Community system ❑' Private Depth to!Water Table60-- ft. ` Character of soil to a depth oft3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E]4 Adob Hardpan E❑ F Previous Application Made: (If y date_-------------------) No ❑ New Construction: ❑^ NI-IA/VA: Yes E] N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer Visav;,ailabylo%200 feet.)Septic Tank: Distance from nearest well __ - ' mion-_ __Dist � Q•-----._. Materiep. - r ---- __Liquid de th--:--: ---¢----Capacity- I No. of compartments --�-.�---------.size- -- t-- -- --- q p. 1 I ...- ��--- Disposal Field: Distance-from nearest well_ _:_. Distance, from foundation___________________Di ance to nearest lot line_--_----_--______ Number of lines__ ------______Length of each Iine�/l;_�-j7v-_Width of trench ---------------------------- Type of filter material_____�.��___-__-Depth of filter material--.- Tota length_-_--��Q______________ __________ � - Seepage Pit: Distance to nearest well.-------------- -__-Distance from foundation--------------------Distance to nearest lot line_- ---------- ❑ Number of pits-.! - ._--Lining material - -,-- -_--_Size: Diameter-----------------�Depth Number Cesspool: Distance from nearest weld___-t-_"- !Di`sfgrcme fr' foundation_______ "5___..Lining materiafi__.__________________ i ___-__Liquid Capacity gals. [] Size: Diameter-...'--[---------- -- --`._ Depth --- 9 P Y Y= Distance from nearest buildingCli ---- Privy. from nearest well _ � Distance-to nearest lot line--- ----------------------------------------------------�=------------------------------------ -------------------- I 8 Remodeling and/or repairing(describe:- E `<< _,} /' tcl'/ �------------------ ------------------------------ ------------ -------•-------- - -- -- it = r fire $ u 1 Sz �9 -- xa - --------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ---7 vf f t ------------------------------------ -------- -------------- ----------------------------------------------------------------------------------------------------------------------------------------------- - ---- - -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules andregulations of the San Joaquin Local Health District. (Signed)--------(41 ----------By.- -----i ----- -------- --r----- ----------- ---- ---- ----------------------------- (Owner and/or Contractor] It -.......I--------------- -----------------------t -------------------------- (Title)---+ - - ------------- - -------- - - - ----- -------- r. (Plot plan, showing size of lot, location of system in'relation to wells, buildings, etc., can be placed on reverse side). 1 R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- -- -- - ---------- - ------ ------------------------------------------------ DATE----- 4--f3 ----------------------------- % REVIEWED BY------------------ ----------------- - - - - ----------------------------- ------------ -°------- ------------------ DATE------------- ------------------------------------------- BUILDINGPERMIT ISSUED----- ------- ------- --------------------------------------------------- ------------- --------- DATE------------------------------------------------------------- i and or rec mendaf s.` i ! t --------------------------------- - - ---------------•------- -__ . _. - --- 9 - ------------------—:7;_ l -.- V----- ' ? -A4----------n' °r r"'�--- ------ 0'r - A --c�--�-�'----- -fir- --- ; d Sfax. 4J ie t ---- --- - - 6 �� - -_ . - t [ ct,►1y�vr t-prrf . o � y��f �` t ;j�— rah✓( y.�` �'"°�d l FINAL INSPECTION BY:---------A-- --------------------------- ------------- ------ Date------------------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o.