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FOR OFFICT�E: Permit No. . ----APPLICATION FOR SANITATION PERMIT P e -------------------------------------------------------- -(Complete in Duplicate) Date Issued --------- ------- ------- --- --------------------------------I----------- This Permit Expires I Year From Date Issued Application is hereby made to 4 he San Joaquin Local Healfh District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND , LOCATI-011-N L710i----eTf --------"Ag^--------------------------------------------------- -----------------------------------------------------------••---•-•------------------------------•-- Owner's Name- --- / ------------••--------------------------------------- Phone e ........................... - Address--.-.------70---- _- - ------------------------------------- -----------------------------------------------------.... Contractor's Name =------------3---a ------------------ --------------------------------- _/----------Y-----------------•--------- ---------------------------------- ---- Phone.. Installation will serve: Residen�e [D'Apartment House El Commercial E] Trailer Court E] Motel [:] Other C1 Number of living units: ------:'N_umbgr-of-bedrooms _--2.__ Number of baths Lot size ---- ------------------------------_ FS Wafer Supply: Public Sysfem�41�ommunity system [I Private F1 Depth to Water;Tablels:v.ft— Character of soil to a depth of 3 feet. Sand Ej Gravel-0 Loam 0 Clay Loam E] Clay ❑ Adobe Er--Hardpan E] Previous Application Made: (I i,yes,date--.-----------------) No 01New Construction: Yes 21"'No El FHA/VA.. Yes [] No �— TYPE OF INSTALLATION AND SPECIFICATIONS: 1� -(No septic tank or cesspool permitted if public sewer is available `within 200 feet.) ' Septic Tank: Distance from nearest well/w�------Distance from foundafion---1�0_ ......Material------------------------------------------------ ii --- lr_,_ --- EP/ No. of compartments--------A'--------------Size-----------3-_X- 4-X-2----__Li quid clep�h-------j4�- ------._Capacity..J�D Disposaj/Field: Distance from nearest Distance from foundafion-/At-------------Distance to nearest lot line_-----_--__Number of. lines-- --------------------------------•Length of each ltne__470------I-------------Width of trench--------- ----------------- Type of filter material-----��__C-�--------Depth of filter m'aterial-------It..............Total length.......:.,rk ........................ Seepage, Pit: Distance t614 nearest well__*wr (------.---Distance from fddhdation__�eg.............Distance to near-est lot line__�s-------------- Number ofi' 1pifs----J---------------Lining materia)---XqA1_ __----Size: Diameter----- -7_A_ -------De- 1, At&----- pfh----------- - ---------- - _ - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__}---------_--.---.-----------._-_.-. .� " ❑ aferial__}----------------*----------- F71 Size: Diam lie0ter---------------------------------- --- Depth---------------------------------------------------Liquid-- Capacity --------------------------gals. 111i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------❑ ----------------------------- Distanceto nearest lot line--------------------------------------------------------------------------------------------------------------------I---------------- ------ s. Remodeling and/or repairing (describe]--------------_-----------_-------- 1 --------------------------------------------------------------------------------------- -------------------------------------------------------------------------- - V" ---------------------------------------------------- -----------------------------------------------------------------------------------------I------------------------------------------ , . --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------I I hereby certify that I ha4 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. ct (Signed)---------------------------------------------------------------- - ------- - ----------- -------------------------------------------------------------------(Owner and/or Contra r.) ------- ifle)------------------------------------------------------------ By:---------------------- .......I - --- ------- ---- --- ------------------I---------------------------------------------(T (Plot plan, showing size of lot,,,location of system i lafion to wells, buildings, etc., can be placed on reverse side). .4. FOR DEPARTMENT USE ?, Ly Al APPLICATION ACCEPTED BY----._ --DATE----- ---------------------- REVIEWEDBY----- 11--------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED----LM------------------------------------------------------------------- ------------------------- DATE------------------------------------------------_---------- Alterations and/or recommendations:-------------------------I--------------------------------------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ...........----------- ------------------- -------------------------- -- -- --------------- ------------- - _ -.--------------------•-------- - -- ------ ----------- ----------- ---------------------------- ----------------------- ---------------------------------------------------------------------------- D --------- --- - -------- -FINAL INSPECTION BY ----------_------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,Core-11 tic Tracy,California re-9 Rrvimrc,j3.59 F.F,.co.zm a-ra