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FOR OFFICE USE: ----------------------- ---------------------------- - ---------- --- --------- APPLICATION FOR SANITATION PERMIT Permit No. os. ------ - - ------- ---------- --- --------------- (Complete in Duplicate) Issued Date Issued --------- ---- -- -------- ----- --- ---------------- 2-03--ICeV--t'J(o . This Permit Expires 1 Year From bate iss 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. -7�� fs s. 2�u-x Y .: JOB ADDRESS AND LOCATION. ......04 0 Owner's Name----------J_r>A,,------------44- K_. QO& ----------- ---- ---------------------------------- Address -------- Phone --- Address-----•----•------.. ------ --------- Contractor's -------Contractor's Name-------.. -------- Q ��` f -- ------ ---- Installation will serve: Residence IN Apartment House ElCommercial ❑ Trailer Court ElMot I [) ;OtPhone er ❑Number of living units: ---1--_ Number of bedrooms __2= Number of baths r� Lot size ---__ J ,l� ..... Water Supply: Public system ❑ Community system ❑ Private JZ Depth to Water,Table �(o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 21 Adobe ® Hardpan ❑ Previous Application Made: (If yes,da#e-_ --- _--_1 No N New Construction: Yes ❑ No Z FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public=sewer is available within 200 feet.) %J w`` Septic Tank: Distance from nearest well-______________Distance from foundation-----------------_ Material--------------------- El No. of°compartments------ -------- -- - Siz ---- ------------ Liquid dePth__ _____ _____________Capacity f ❑ --i-- eR� Disposal Field: Distance.from nearest-well' --�Diffancefrom fondaton -_---------Distance to nearest lot line----------------- Nirnbei'4of lines-----------------------------------Length of each line-----------------------------.Width of trench---------------------------------_ I Type of.filter material-------------------------Depth of filter material----------------------- lengfh------------------------------------------ Seepage Pit: Distance to nearesf,;wefl---A90----.---Distance frt foundafion_,/O.............Dista, ce to nearest lot line----S'___. Number of pits------- Y_.,-Lining materiai__S _ -Size: Diameter_ l'_yg`_`_De th--._ . - p € --------------- Cesspool: �D tante from nearest well------- ------Distance from foundation-_-_________-_.-_-.Lining material_____.......____._..____._______.__.. ❑ `q", � `Size: Diam�er---------------------------t--___'___Depth------------------------- -------------------------Liquid Capacity-------------------------..gals. e Privy: Distancfrom nearest#well;,-______________________________ _--___-Distance from nearest building----------_ -------._---------.-----..._. ❑ Distance to nearest lot line- ""_'" - ----------------------------------------------------------- - Remodelin and/or re airin, describe :______. � C? , e�'1_, _,�1 ✓_CGf / ------------------- --------------------------------- ---------------- _______________- -----------------`-----------------------------------•-----------------------r-----•------------- ---------------_ -_ - .. . . --- --- �E yt f - N _.�r..e........... ________________________________________________________________________________________________ _..__._______---_--_------.--__-_-----------_--__-__------------___---------__------._------_--------..-------._._.-__._ O 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 nd rules and regulatio s of' he San Joaquin Local Health District. . (Signed) 1q � 'f►l sP .-- '�/r - ------------ -- wn and/or Contractor) "1 Bw F Y --------;-----------(Title)-- - --------- --------- - - -- - ----------- (Plot plan, showing size of lot, I ation of system in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -- -- ----------------------- DATE---- REVIEWEDBY- --- ----------------------------------- - ------------------ ----------------------------f----- ---------------------- DATE----- --------------------------------------------------- BUILDING PERMIT ISSUED &'l = ---------'-------------------- DATE---------------------------------- Alterations and/or'reco n dations:"r.._ °-""'" ... = -------------------------- -- -� - -- ---- T- -lk 6.6------------ r �-�4e i----- - a a-. --------,�------- - ------ - ----- ------ ---- -- ----- - -- - -------- - • -------------------- -------------------------- -- �' " _ ..^ VU---------------------------------- - --------- ------------------ - " ' 1a is i Y �j It 1 ----------------- ----------------- ------- ----------- -- ----------- --------------------------------------------------------------------------------�----------f----- --------------- ------- ---------------------- FINAL INSPECTION BY:--------- --------------------- ---------- Date.-- -46_..:= C)------------------------------------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Codi,California Manteca,California Tracy,California F.P.cfl. 5