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FOR OFFICE USE: - ------------------------------------- ------------------ -- ____________________.___.__..__.___.__- ______________- APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate)_ This Permit Ex ires i Year From Date Issued Date Issued 25-7 —p2.:or Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta 'the work herein descr ed. ,,I This,application is made in compliancewith County Ordinance No. 549. a ,7j c �. r r - r -_ i�-y!._ .-- _-__ 5 JOB •3�DDRESS AND L CATIONcS--- ---- �a-- - -- -_---=•- �I�------ --��---��------��a-�---�------ -�--'--j-�'--�-�-----�D ; a's �f I Owner's Name` pppp)� - ill l/ ------------- Address._ , ' a !-r 1 ---------------------------Phone------------------------------ ..._ WI _, Contractor's Name ------- ------------------------- -------- Phone----------------------------------- Installation will;.serve::Retidence ❑ Aparfinent Douse ❑ Commercial (] Trailer E-vv* [Motel ❑ Other ❑ 1 Number;af.living units: -]--- Number of bedrooms _ -r Number of baths -_' Lot size __-144.RE7A.6�-___-__________________ Water Supply: Public system El Community system E] Private .�Depth to Water Table _-f�_ it. Character of soil to a depth of 3 feet: Sand.Gravel ❑ Sandy L am ❑ Clay Loam El Clay ❑ Adobe (] Hardpan ❑ +' Previous Application Made: (If yes,date__f?�!_.._._. -----) No [ New Construction: Yes 0'-*'No ❑ FHA/VA: Yes ❑ No i -TYPE 1OF.INSTALLATIONAND SPECIFICATIONS: k -_ - F . -(No_septic tank o�'cesspooh perntitted if public sewer is available;-within 200 feet.) Septic nk: Distance from``nearest well__._&D,__Distance from foundation---I,�--------_Material-- _No. of compartments .2�___ :----- - i --Liquid depth--- ------Capacity-----e Disposal Field: Distance from nearest wel___ �..._Distance from faoundatior._��_______.Distance to nearest lot Iine__,��_.__._ -�- -'Number of lines.---------'rr—_---------------Length of each Iine.�Q_->t_��__..Width of !.- trench _._..___�_(- - __ Type of Vier mafierial.__ �-C�--Depth of flter!rnaterial____._ _--Total length _ ____-.;_,_____-__._ -___--.-___._ _____ See a e Pit: Distance to nearest well------------_-------Distance from oundafion--------i1__I.__.Distance to ne rest I W _ lot 'line.------------__-- ❑ Number of pits - ------- -----------Lining material-------µ- -- Size: Diariester` ------------Depth -----------------------•--- Cesspool; Distance from nearest well-----------------Distance from foundation_._-_ 7 ._7 Ll- Lining materia _____________________ _ ❑ Size: Diameter-------------------------------------Depth-------------- ------------------- ---- Liquid Capacity----------------------------gals. Privy: Distance from nearest well_---------------------------_------------------Distance 'rata nearest building_i --_-- -----------_________._______- ❑ Distance tofnearest lot line------------- --------------------- -------------------1----------------- Remodeling and/or repairing {describe)--------------------------- -------- --------- ------------------------- -------------I--------- --------- ------------------------------------------------- ------------------ ----------------' ------------ I i S ------------, .,.. a rk will be -------------------------- ------------- ----- --------------------- _ __ t I hereby certify that I havW'prepared this applicafion::aKd'th'af'fhe wo•� o�one'-in accordance with San Joaquin County ordinances, State lawss�yyanyrule ndregulations of fhe San;Joaqutn 'Locat-"R;alfk,District. C/(gym `_//7/�{�� (Signed,l -+ ------- --------------------------------- (Owner and/or Contractorl ------------------------------:----------------------------------W------------ ---------------- ---------A,r -------Title (Plot plan, showing size of lot, location of system in relation to wells buildings, efc; can be laced on reverse side). FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY-------- 0'---------------------- ------------------------------- ---- PDATE. -- • REVIEWEDBY- ------------------------------------------- --------------------------- ----- -------------------------------a_:............._:.DATE---•---------------•----------------------- -•------- BUILDINGPERMIT ISSUED--------------------------------------------------------------•--------------------------------- ----- DATE------------------------------ ----------------------- Alterations and/or recommendations.-,-,.,.--,.............. ----------------- = = = ----------------------------------------------•---------- -------------------- ---------------------------•- -------------------------------------------------------------------------------------------------- -------------- - ----Z. --'- - ------------------ --- --------- -- ----------------- ----�----_ --•---------------•-------------------------- 1 FINAL INSP - -- - i.l7- Date-- - - -// -- =f..f_ 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street m 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.