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FOR OFFIC USE: /> --------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- ----- ----- --- ------'- - - ------------------ "'y (Complete in Duplicate) �• Date Issued __Z_:��/2=_j:�7 -----_____ ---------------.---------__._._-. 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 with County Ordinance No. 549. JOB ADDRESS AND LOCA ----I---- .......... .------ 5'` is- ------------------------------------- Owner's Name----------------4L-'s-<-0--` � V,,A7_2-Q ----------------------------------------------- Phone- Address----------------- hone-Address---------------- � —t? - ---- .kE--------- ........................................I................. Contractor's Name A__......_ "r` -•--- ---__ s._ _...__ --.1�G'..�•....................•-``---- Phone�Wo�— Ll ;C,_� --- �/ Installation will serve: Residence�Vpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living __-- Number of bedrooms ._ _ units: �. . Number of baths .__I__._ Lot size ------�p_ ________________ Water Supply: Public system % Community system ❑ Private ❑ Depth to Water Table 6e ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: (If yes,date---------_---.------) No ❑ New Construction: Yes p Nc FHA/VA: Yes ❑ No p TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeyticTack: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- 1511 411 No. of compartments----- --------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Dispo sal Field: Distance from nearest weILWIA-169-_._Distance from foundation.:__ -------Distance to nearest lot line--- 4— f -_.._ Length of each line__-_ _. er fCg114T1�1Br Number of lines------- ----------------- - - - g ------_-.r---Width of french Add. Type of filter material? Depth of filter material ----Total length------�5.-------------------•-- O Seepage Pit: Distance to nearest well----------------------Distance from foundatimp----------------_-Distance to nearest lot line-__--._---_-_-_-• ❑ Number of pits__________________ ___Lining material------ Size.11 Diameter--------------- Depth----.. -------------------------- Cesspool: Distance from nearest well_---------------Distance from _ :foundation_,-__,_-_________._.Lining material.-_____ .-___.-___._-___:.---_-_-_-_. Size: Diameter- ------------------------------------Depth--------I--------- -------------------------------Liquid Capacity-------•----•-----------_-gals. , Privy: Distance from nearest well-------------------__-_ __--- *w 'Distance from nearest building,_„.__ _______-.__.-_------------- ❑ , , Q_ Distance to nearest lot line-- --- -------------------------- ------K-,._.-=-'-z��•---•----.._._..--------------•----------------•----•---------••-•------------------- %'v Remodeling and/or repairing (des cribe):_.---..-____. _ ------------------- ---------- __ ___ ppo mep ------------------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, anles and regulations of the San Joaquin Local Health District. (Signed)--------- �Cla' no4l--------------------------------- --- ---Leills, --------------------------------------------- Contractor) SEPTICTANK SERVICE✓By:---- F Minsu Avef+t9 -----•--•--------------- ---- ------------------ --- --------------(Title)-------------------------------------------- - ------------ (Plot plan, showing size of lot, location of system in rely n to bui Ings, etc., can be placed on reverse side). p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- �! - ---------------------------------------------- DATE---- = - REVIEWEDBY------ ------------------------------ ---- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE---------------------------- --------------------------- Altera 'ons d/Dr re�c,o-mr�mendations: .- ---- _ ' ------------------------------------------------------------yy-- ��---------- ----------------------------------------------------------------------- . FINAL INSPECTION BY:..... . -- d-------------------------------------------- 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 Manteca,California Tracy,California F.P.CO.