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r-UK UhUl �,L U_'It: t -------------------------- --------------------------- I_._..._-___ ------11---------------- ----------- ----------------------- ----------------- - APPLICATION FOR_SANITATION PERMIT Permit No, s .11f...... ....... --------------------- ----------------- (Complete in Duplicate) ----------- ----------- ---------------------------- This ..Permit Expires I Year From Date Issued Date Issued' .c ___= :_ � ---- ------ This 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. T j06_AtYD�RtSS' --- --------- __H -- --------47W Owner's Name--------- lotnb--------- ---------------------- --------------------- ---------------.. Phone------------------------------------ Address--------- ----------8?2X------133k,_---------M_,RN__Tr_Cj.q . .............................................................................. Contractor's Name---- --- ---------------------------------------------------------------I------------------------I--------------... Phone----------------- Installation will serve: Residence Apartment House Ej Commercial E] Trailer Court [-] Motel El Other ❑ Number of living units. Number of bedrooms _-2-Number of baths I--- Lot size _-ACRE-194 e: Water Supply: Public system E], Community system E] Private E-1Depth to Wafer Table y_---- ff. Character of soil to a depth of 3 feet: Sand [✓�Gravel El Sandy Loam Ej Clay Loam E] 'Clay E] Adobe E] Hardpan 0 Previous Application Made: (If yes,date----------7.-------) No [r]` New Construction: Yes E] No [a-'THA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: - 4 (No,sep jic jank or9cpsp"I_p.: if-public_yblicsewer.is-availablewtRh in.200feef.) Septic Tank: Distance from nearest wali-----------------Distance from foundation---------------t__ Materia! El No. of compartments------------- ------------Size-----_--------------------- depth--------------------- Capacity---------------------- Field: Distance,from nearest well- _S01 -----Distance from foundation-__1-0..._--_-Distance to nearest lot line-S-------- FXV�rl Allir(q Number of lines------------/--------------------Length of each line-----10.0-------------Width of trench_._.__.__- --- ------- fm D Type of filter material---1?0_C� ---Depth of filter material....../17__1`._._1ota1 length------------------/09?------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------:------Distance to nearest lot line_-.--.-_-_._--_-_ ❑ ine,---------------- 11 Number of pits-----------------_.__Lining material------ ----------------Size: Diameter_._.__-----__---------Depth- ------------------------- Cesspool: Distance from nearest well-----------------Distance from,foundation------- ------------Lining material--______-___-____...____-- ---------- ❑ Size. Diameter--------------------------------------�Depfh----------------------------------------------------Liquid Capacity..------------- gals.- --------------- -kw - Privy: Distance from nearest we --------------------------- ----------------------Distance from nearest ---------------------------------- ❑ --- Distance to nearest lot line--------------i ! ------2------------------------------------------------------------------ J0 Remodeling and/or repairing (describe)_____________________._______.___.__..__ _ I----------- J0 ------------------------------------------------------------------------------------------------------------------------------------------- ---------I------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------- ------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County ordinances, Stife laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ 1d ------------- ----------------------- - -------------------------- ----------- ----------- -----------(Owner and/or Contractor) '------------ ----------- -------------------- - ---- - -- ---- - (Title)------------------z-- ------- -- .......(Plot planlshowing ... size of lot, location of in relaii:o-n c`an-6-epl�ZQ—on-rever—se siJie). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -------------------------------------------------------------- DATE--------- REVIEWEDBY-------------------------------- ------------------------- -------I-------------------------------------------------------r---- DATE----- -- ---------------------------------- BUILDING PERMIT ISSUED ---------- DATE------------- ------- ------------- Alterations and/or recommendaf ions:--------5- ------ fid_5P a �j MAY- AF-5 W `rtmo!- ------------------ -----------------------I------- ------------------------------------------------ _ 1 --- A ------------ -nim----- 2r------ FRC 1-----.4-4/V ------/-&f__r_ L F-__t?--------- - ----------- ----------- - ---------------------- - ------- --------- --- ------ ------------------------------ ---------- .... ---------- -- ---------- ------- ---------- ------------ . .. ........... _A6--------------- -------------- FINAL INSPECTI ,Y9 10 - ---- -- Date_-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi, California Manteco,'Callfornfa k Tracy,California F.F.Cu.