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FUR OFFICE USE: ------------- =-------- ------ ------------------- ----------------------------------------- --------------- APPLICATION FOR-SANITATION PERMIT Permit No, f.(�_. ------=------------ ------------------ --- -- (Complete in Duplicate) Date Issued/f_s,�?.;_?-_6.5_ ------------------------------------------ ------------- 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 herein described. This application is made in compliance-wi.th-Coup rOrdinance•No. 549.00 t�� ' JOB ADDRESS AND LOCATIO -------•------- _ ---Vtll}l Owner's Name-------- YS-------•------- - ------------------ - - Phone------------------------------------ Awl p Address--------. wl------ Zo......IL --------------------- ---------------------------------------------------------------------- Contractor's '�-�.p�la[ ------------------------....-.---••--------------------------:_-•-- Contractor's Namer _` Al�� ...:.... Phon ------------------ Installation will serve: Residence [] Apartment House ❑ Commercial [Trailer Court ❑ Motel ❑ Other ❑ f - � Tea s -------- Number o ath_s -------- Lot size .- - -�Tr�_- ----•- i Number of living.units_;--,,,��Number of bedroom _ _ Water Supply: Publicsyste&-�,❑tvCorrimuP iiy ystem ❑ Private �Depth to Water Table 14' 7�t. I Character of soil to a depth 0_3 feefl�and'�ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Mad {lfes,dateR11_____--------} 'No 2r-'-New Construction: Yeso ❑ FHA/VA: Yes [:1 No TYPE OF INSTALLATION AND SPECIFICATIONS : _„ _ (No septic tank or cesspool permitted If public sewer is avedeble within 200Jfeet.) t Septic Tank: Distance from nearest tilwell-___��7__0... 1Distan e from foundation----�I ._.__._.M ter) I_ CQ/VCK "�E----_--. I # No. of�compartmen : _Z _______ Siz __ _._ ---Liquid depth____. __Capacityo9.0.Q-- q ? r Disposal Field: Distance from nearest,we'IL_�?�-_.IDistancerdm-fou cl tion_-_-/Q_-------.Distance tonearest lot line---J-------------- Number o �f lines-_ -__----- _.. '_!Len th-ofyeach,line.�_5__0..._.,,-- Total lWidth,of trench. �r. } - eg - � Type of filter material jIDZC-�1...�Deth of filter material__ _ _ n th_______________________ �____.._ Seepage Pit: Dls#ane onearest well___________________Distance from foundation "+ 1 Istance to nearest lot line-..-__--__---..._ ❑ Number.of pits.; °, Lining mate iaf----- t__=.'_...Siie�Dlameter!'`�..........._-�-_--Deptn_ ---- ------------ < , -''�"t,we ,_._.-Distance from fo6h'8;5 ion`s_ Distance f pm,nearest�well t ._ "t..'Llnmg mateisl__ } O El Size: Diameter_________________ Nth --Liquid Capacity.---------------------------gals. rh Privy: Distance from nearest we1l--------------------- ...Distarce from nearest building.__._.____.___.________._____.___.__. ;I Distance to nearest lot line----- Remodelingand/or repairing (describe)------- -------------- ------------- - ---------------------------------------------•----------------------------- ----------------------- ------ I ------ ------------------------ y ------------------- --•-------- -•------ ---- -;-- ------- ------- -------------- -•------------------------•---------------------- --------------------- ------.. ---------------------'------------------------------------------ ------ I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances; St a and rul and re ulations of the San Joaquin Local Health District. (Si ned} - ---- ----- ----- - ----- -1 P �-------. (Owner and/or Contractor) ---- ------- - ! '(Title) _ (Piot plan, showing size of-lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). 4 t ' ij FOR DEPARTMENT USE ON'tY APPLICATION ACCEPTED•BY :'7 .' ?.-Q ---- -------- ----------- ---------------- ---------------- DATE----------.I� �r REVIEWffBY-=-------------------------------------- - - -------------------- ----------- ----------------------•----------------------- DATE------------------------------------------------ BUILDINGPERUT ISSUED-_------------------------------------------------------------------------------------------------- DATE------------------------------------- ---------- Alterations and/or recommendations: - - = ='- --------------------------- + ---- -- ----: ------ t - ------- ..3 ------- ------------------------ .� -------------------- - ------------------------ - ------ ---- } FINAL lNSPECTIO -- ----- --- - Date........ L1.-'-f. -- . SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 F.kaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 'Stockton,California Lodi,California Manteca,California Tracy,California