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FOR OFFICE USE: ---------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 2.42_ ~ t --------- ------I------------------------------------ -- (Complete in Duplicate) --------------- This Permit Expires 1 Year From Date Issued Date Issuedl.rL"� 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 co pliance with County Ordinance No. 549. 1"` A JOS ADDRESS AND L C ION.*W ... `---------� �- ?-- Owner's Name-------IqF-y ----------g ---------=- - . Phone---- � : -------------------------------------------------------------------------- ---------- Address------- --------------/Z------------------------------------------------------------------------------------------•-•---------------•------------------------------------ t Contractor's Name------- K'/4r -----!�t---------------------------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence 1"1�0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms . _ Number of baths __/-.- Lot size _. GI -..-_-_.-..._--------.--_ Water Supply: Public system ❑ Community system ❑ Private IX Depth to Water Table 1.10. ft. Character of soil to a depth of 3 feet: Sand 7 Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay 9, Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------) No New Construction: o Z' FHA/VA: Yes ❑ No 2r�'_ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ __-Distance from foundation--------------------Material-.-.._..-....-.-_---.---..-.-------.--------.-. ` ❑ No. of compartments--------------------------Size--------------------------------Liquid depth.------------------------Capacity----------------------- Dispasal o d: Distance from nearest well.__�.��.---..Distance from foundation_..-f.p--------Distance to nearest lot line---:5�. R Number of lines----------------1___-_-----------Length of each line------- -[J_O-. -._..Width of trench--... -----------------__--- Type of filter material._.RQ.0 ..-Depth of filter material-- Total length-----------------fQ-0--------------- Seepage Pit: Distance to nearest well- Distance from foundation..._____----_---._.Distance to nearest lot line--------------❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.--------Depth---------------------.---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------.------_---.-. ❑ Size: Diameter------------------------------------.Depth----------------------------------------------------Liquid Capacity----------------------------gals. t Privy: Distance from nearest well-------------------------------------------------Distance from nearest building..-.....-.---.--..--.------_-----.._...--. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------ ----r-------- Remodelin9 and/or re airing (describe):__4.(_ ... Z-i,v ! -----------------------------=------- -------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- -- -------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- --------- --------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- 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 regulations of the San Joaquin Local Health District. r fes, I (Signed)_-- - -_+- _r --- -- �4' [Owner and/or Contractor] �. -- -- - ------------ -- ----------------- ------------------ -- -------------------(Owner ----------------------------------------(Title)---------------------------------------------------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed-on reverse side). = F -�- FOR DEPARTMENT USE ONLY /� w APPLICATION ACCEPTED BY------------ -f i �.,..0.----- ---------------- ---------------------------------------- DATE-----�. =---.r�___'.IIZ-------------------------- > REVIEWEDBY-------------------------------------------- -------------------------------- -------- ------------------------------------- DATE------------------------------------------------------ ---- ; -� BUILDING PERMIT ISSUED---------------------------------------------------------------_--------- ---------------------- ---- DATE--------------------------- - ---------- Alterations --------Alterations and/or recommendations:-----------b�/%_5.TES.......COV-1-5-iR=(=----p---------- —r-a------`/.�5 Q.�1-.--.... ------------------------------------------ 4K5 X11-� ------/A(5m_4 . D-------�-5-------X11 -t AT M - ------------------- -- ----------------------------------- ---------- ---------------------------------------------------------------------------------------- ----- i -------------------------------------------- ------------- r- --�-.-------------------- -------------------------------------- -------------- ----- -------------- ----- FINAL INSPECTI N B - --------- --- ---- -- -- Date............5_77 Z"`6&-' ------ -- r SAN JOAQUIN LOCAL HEALTH DISTRICT - 1601 E.Haxellon Ave.,,.y;; 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi, California Manteca, California Tracy,California Stockton,California;?' , ..,,