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FOR OFFICE USE: ----------- ----------- -----`---------- ------ Permit No. ------------- - APPLICATION FOR SANITATION PERMIT -------------- (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 herein described. This application is made in compliance'with County Ordinance No. 549. JOB ADDRESS AND LOCATION - �-)-1-'2 - , -�--------- rQN ------ - !� -----------.:. ------------- ----- Phone------------------------------------ OK ---••------•-----------------.----• a Owner's Name-------------------•----------- AK-�� .��._��-- '----- - ----------- - - - Address-----------��41- 213------- _' 1: . I'Q :r -------------•- .- f Contractor's Name----- ----------- 1�1-+451�` iJ.... ZAsf-t-- ------ Phone------ •----•-•-----------•-------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] �yMotel ❑ Other ❑ i Number of living units: J----- Number of bedrooms -------- Number of baths.,3--_ Lot size ....1?Cl - ----- --------•-------- I Water Supply:; Public system ❑ Community system ❑ Private eDepth to Water Table 1 _ - ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam [-] Clay Loam C] Clay ❑ Adobe E] Hardpan ❑ FHA/VA: Yes' No Previous Application Made: (If yes,date..................- I No New Construction: Yes �No E] El TYPE OF INSTALLATION AND SPECIFICATIONS: �No-septic--tank-or-cesspool=permitted-if-public server is evailabfe within zoo feet.) ,r Septic T Distance from nearest wall_ :__._._.-Distance from oun anon...........:...... Mate sal.....- ON C -- - - l No.�of compartments -----------�-` I -�1-�--X---------Liquid c�Pth-- -`-�- L.. ---Capacity--1--- � Disposal Field: Distance from nearest weld_-x459_..Distance from foundation__-./.Q_-....._..Distance to nearest lot line....._...__.... i �"~� Widthlof trench.------2.LP Number of lines---------- ------ --- Length o` each l ------ -- �- i------------- Type of filter materia4_-}�-QC}-------Depth of kfil ,.material._ _.I?-___-___._.Total length-_-..--..__1s __________________ pg { See a e Pit: Distance to nearest well..............._..._ Distance from fo.undat,ion...=.....____..._....Distance to nearest lot line.-----._....._... Number of pits. Depth---------------------- ----- ❑ ------Lining material- _ -.- Size: Diameter------------- -- -- - - �. s t Cesspool: Distance fr �,n omea,rest well- j---.____.Distance from foundation_._..----------- - Lining material-------------------------------------- 11 Size: Diameter- i-------------- ------- Liquid Capacity gals. ❑ Depth � . .- Privy: Distance f4or:n nearest well-------------------------------------------------Distance from nearest building--- .---------------------------•----- ❑ Distance q }earest lot line ------------------ -- ----- s~ -_.. -=� - F Remodeling and/or repairingjdescribe :----- - - ------------- ------------- ---------------------------------------------------------;------------------------- - ------------------------------------------f -------------------- -------------------------- ----------------------------------- f -`; - -: ----------•------------==--•----------------------------------------------------------------------------------------------- ----------------------- --- ------- ----- --#•----------- �'--------------------------------------------------------------------- I hereby c r ify thatll•have 4pared this application and that the work will be done in/dccoraance:with San Joaquin County ordinances, 5t laws, and ruleWap'�d regulations of theSan oaquin Locai Health District. �� --------------`------- {Owner and/or Contractors (Signed)------- d`'..... 1- tt ! 3 - 4 B •-- '--- ------- --- '= ------ - _;---:---- �:;;:;:{T'�) ............... (Plot plan, showing size ofilot location of system in' relation to wells, buildings etc., can be pia ec d an reverse side. f FOR DEPARTMENT USE ONLY {{ �' - -------------- - APPLICATION ACCEPTE,6" BY---------r lR `O=4. ----------------- - ----------------------------------- DATE ! -. Q.__'_.�P REVIEWED BY------------------ _=== < - _w_.---_-_. " __ -: �,- v-- ----------- ----------- DATE-----.------------------------- ----------------•---------- BUILDINGPERMIT ISSUED---------- --------- -------------------------------------------------------------------- ----- DATE------------------------- ----------------- -------------- Alterations and/or mm recoendations:-------------------------- r _ W _ .___ _ --------------------------—fir r -- t✓i }9 ti=j--- ----- -------------------------------------- --- } -------------------- _ ------- --------------------------------------- ------- -- FINAL INSPEC Date..... . s SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. t Soo West Oak Street 124 Sycamore Street 205 West 9th Street 5lockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press