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'FpR OFF4CE USE: ---------- -- � APPLICATION FOR SANITATION PERMIT Permit No. F ----------------------- (Complete in Duplicate) Date Issued --- t This Permit Expires 1 Year From Date Issue -------------------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install work herein described. This application is made in compliah ce with County OrdinAnce No. 549. r JOB ADDRESS A TION ----------- �} Phon --`'" -------`---L- Owner's Name Address----_- ••------- �23------ --- --- - - -- _ T t r ��----- Phont�-=--� Contractor's Na ,�.__ate 1�:-•F-------- t Installation will serve: Residence ertment use ❑ Comm rcial ❑ Trailer ourt ❑ M I E] Other [I Number of living units: __�_'_+��Number of bedrooms Number of bat f Lot size. /' Water Supply: Public systern?Elt Community system ❑ Private epthtto6 Wate'"Ta e r 3 t• Sand Gravel Sand Loam ❑ Clay Loam n#*G.Iay ❑ Adobe Hardpan ❑ Character of sail to a dept�dt 3-feet: Sad ❑ ❑ Y . , Previous Application Made: (If yes,date------_.--_.__.--_.) No El New Construction: Yes ❑ No FHA/VA: Yes ED] No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i e-ticf r. e from nearest well-----------------Distance from foundation-------------.------Material-_"----------------------------___..________... No. of com artments. -Size--------------------------------Liquid depth Capacity A,o o Distance from nearest wei1 �---.-Distance from foundation._______ __..Distance to nearest lot line______ __________ p � - Width of trench._ .__ _ � _ Number of lines"R _.__� Length of each line__��------�;�-- . "- --Total length-_ ._____ h..Type,of�fiifer�mater.,al _._ epth of flter,mater,al _ .-------- ��,,, _ Seepage Pit: Distance to nearest well------------------ -_Distance from foundation-------------------.Distance to nearest lot line_ Depth-. `�' ❑ Number of pits----------------------Lining material---------- ----------- Size: Diameter p —* ", Cesspool: stanc from neareI .st well-----------------Distance from foundation-__"..._-._--.--- Lining materia4--.-- __-_-_---_--__."__-------'I :Depth------------------------------------------- --------Liquid Capacity--------------------- 1' gal r .Distance from nearest bui.ldin ----- _--________-"- '- y- Size: Diamete`--- ------•---- - ---- ------------ �---------- - - ; 9 " --- -------I Priv Distance from nearest 467, � : rttJ- - -- -----"-- --_- ElDistance to nearest lo!%I ey- ------ --------------- - ----=- ----- Remodeling and/or repairing (describe]------------- - �` __r\---- I ' . : 9---------- -------------- ---- - ----- ------------ -------- ------------------------------- ----- rj --------------------------- -- - ;P -- -. ! heri'by1er,tify�t I aveg p red this a lication and that the works i'11 be done in accordance y�`th San Joaquin County l ordinance`s`�St to a laws, a an , ,rV�latlons of t. n� uin, ocal Huai+h"Dis ff ct. _ $ � i � ----------------- (Signed) -(Owner and/or Contractor] SANK #� --- -- ---sep-r-1, gyp,�i3 All--------- . -- 2915 E-Miner Ave., ' i - 5 ----------------"---------------•----------------- - --:� BY: r o la showin i e of�lot locat'an of syste'5ntre! ivnma �s, beildi Kg. etc., an b lace1don�reverse side)..,,,,,,r„� - } DEPARTMENT USE O LY - DATE---- {3 ------------- APPLICATION ACCEPTED BY__.--__-- I REVIEWEDfB:Y DATE_---- - --------------------- ------------------- ------ f ------------------ --------- --------- -- DATE-------- ------------------ -------------------- BUILDING"-PE IT ISSUED------ =_ ----- ------- ------------------- ---------------- Alterations�'a.n /or recommendations:_ ..-__ ------------------------------- ---------- .�ti ---------------------------•------------------------ ----=--------- I ---------- ------------------ ----------------------------------------- ----------- -------- ------- --------- ----------- ------------------ --------------- -- - ------------------------------------------ --------------- ----------- --------- -- - - --------------------------------- ---------------------------------- 1p FINAL INSPECTION BY:.-----C!C. ....0 ------------------ Date--------- -�- ' SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 6.Ha=eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California