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~ FOR OFFICE USE: --------------- . ..4.- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here-in clescrbed. PP 3 with Ordinance No. 549. This a DRE 1e17-.6 !�ad RC IONyeePle"—-County (� f�f/!17/� 1°,�- '"Gt /I� '�� >��------- ----------------------------------------- JOB ADDRESS i f 9f -�S 5o Owner's Name--------• ---- - ----1�--'C� Phone 47 Address-------•- •-- T-------- 6d�11� , --•--- �G.. . Contractor's Name ` f .t4-iV��_/- __. Phone_. fz �®•' Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑ Number of livin units: ___-L Number of.bedrooms 2-- Number of baths /---- Lot size ____- ------------------------ Water Supply: Pubii�C system ❑ Community system ❑ Private IN Depth to Water Table -S-- ft. i oil to ade th of 3 feet: Sand Gravel ❑ Sandy Loam IM Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Character of s p ❑ Previous Application Made: (if yes,date-----------.--------1 No ® New Construction: Yes ❑ No 20 FHA/VA: Yes,K No ❑ �- -- TYPE--OF,INSTAL-L-ATION-ANDTSPECIFICATIONS: - -` ` - = - - -�_� _ �- _ _ _ _ - —+ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- Distance from foundation_.r& -----____--Material-_'T - f --— No, of compartments-------•�---=------------Size__6 `YX�-----------Liquid depth-- --'`---------Capacity_/ Disposal Field: Distance from nearest well. ._..__Distance frorriifoundation �_"---Distance to nearest lot line____-- -_______ of Type - De gth9 off�each mater al_-9__�'^""_"_Total hlength french-?<:f0 __------------ ----------------- Seepage :�-""-_I�Q_/_j`ter XL Number of trines---.__._��_ - Len th °,filte, f y See a e Pit: Distance to nearest well_____________________Distancf {� y` +� Distance to nearest lot line__.___________._ T e of filter material___ lXii --_____ p p 9 ram foundation___._________._-. ❑ Number of pits----------------------Lining material---� _ ,-- ----Size: Diameter----_------------------------Depth--------------------------------- Cesspool: Distance from nearest wefE_____"_..---_4"Distance from foundafion----_..'_--.___.---.Lining material_...----__.__._-___________________. ❑ Size: Diameter--.-- - ------------- ------ -D {h -1'�-------------------------- ------- Liquid Capacity. gals. Privy; Distance from nn''earestt tele- ' ---- '_, --�---'--- Distan from ne` `are t=bu.i g------------------------------------ Jf1« r; ❑ Distance to nearest to i `_ ------------------------- ------------------- ------------------ /' > Remodeling and/or repairing (describe= - - -----;; T � ° ,`�° _, -- _ok-, )---------------------------------- - ------�-- ------ ---------- ----------- l_t-�_ .,4 ------------ -------------------- ----------------------------- . e - prepared PP i `"`. ----------------'----------- ------------------------------- --------------- ------------------------------------ ---------------- -- ------ ---------------- -------^---------- . . , :., I herebycertifythat I have re ared this application and hat the work*will to donerin accordance wlth San Joaquin County ordinan�,Sfate laws, and rules d regulations of the San o quin Local Health District. r C ' '-_ . , �,�' _ _ C ---------- ----------- ---- nd orContractor)_ - — t r - - ----------- I II ---- ------------(Title er By.. ----------- -- (Plot plan, showing size of lot, to on of system in relation to wells, buildings, etc., can be<placed oil revelse side. S t sY ! - - FOR DEPARTMENT USE-OW-LY / APPLICATION ACCEPTED BY---------1--- R`O'-- -------- ----- -------------------------------------------- DATE-------- D-`�L?_------------------------- REVIEWEDBY----------------------------------------- - -------------- -------------------DATE = BUILDINGPERMIT ISSUED------------------------------------------ - ----------------------------------- DA-TE--------------------------------- --------------------------- Alterations"aod/or—re'commendafians - -- E- ----------------------------------------------------------- -----------------------•-------------------- 1 -,* '-------- -------------------- ---------------------- ---------------------- f -- ----- - -- - 1NSPECTI Y:. -. - Date------ -------1--.`--Cl ' �/ ---- --------------------------- FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT I, 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stacklon,California Lodi,California Maniecar California Tracy,California