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FOR OFFICE USE: ------------------------------------------ --------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- 4 (Complete in Duplicate) __._..__._____.__._ ..___ This Permit Expires i Year From Date Issued 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. yY JOB ADDRESS AND LOCATION____ L - fZ._ z,Q �t Tt_ -----11�] _ wTv- ;A," >,. __. 4 Owner's Name--- C1.r_ .{ .- - �I Z`i11 �� ---- ------------------\___ Phone_ 3_~30.1? P--- Address--- _ll __ _l..A�l�.l } - - -J ..T_ _.CIaL.I-�A---------------------------- Contractor's Name='_ ► ° � }i -•-------------- Pho e��o�n-'-�_�?�_7 Installation will ;serve: Residence D< Apartment House ❑ Commercial•.❑ Trailer Court ❑ Motel ❑ tiOther ❑ Number of living units: _.'___ Number of bedrooms _ _ Number of baths ---I.... Lot siie ___-14� - . «.mss hits....,«.,..6 r...�.�..«...�.._.....s - Water Supply: Public system ❑ C`ommunify',ssystem`ED Private JK Depth to Water Table ------- ft. Character ofrsoil-+o a,dep+h-of-3=fee Sand ❑ .IGraveln❑,„=Sand.y Loa m„D.ClayLoa ❑ Cla� t Ad16 e❑ Hardpan ❑ Previous Application Made: (if yes d ate_----_-------------J No ❑ New Construction: Yes ❑ No ❑ FHA/VA Yes:❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted if public sewer is available within 200 fee}.) �► Septic Tank: Distance from nearest welL_ distance from foundation Material_..Material_.�� '!;_ C # 19 No. of-compartments----._____.2�__....__Size-U-00__ ._.-_-Liquid depth___ _______ _---_----_____Capacity_ Disposal Field: Distance from nearest well-a r.bistance from foundation!'e,'_�}��i.Distan�c o nearest lot line`_10Q_ .Number of lines______ __ r _Len Length of each line----_. 9 + _=.Width oftrench � Type of filter material___.. epth offi`t}* material------ $______ _Ttotal length-----_--- r_ _________________. Seepage Pit: bis#ante to nearest well ______ ... ____Distance from=fouradation'__._L411-1__.DNtance�fi.�o-'�nearest Io•t'line_____.___.___._ ❑ Number of pits---- ------------- --Lit-hint material----- ----. Size: Diameter---------- .._.._._.Depth-----.---.---------------------- p Distance- ro oundation.-------------------Lining mated_�___1...___ __._.__._______- - Cess ool: Distance from nearest wel '__�___i_-Distance ! Size: Diameter___.�_ Li uid Ca acit.” fi ❑ f ----------- - -DepA+ - : ----- q P y. -------- --------------gals. ------- ------- -- - Priv Distance from nearest well.-_____.______.._._- --------_-____________-Distance'f o nearest b6ildin' l } ❑. �, Distance to nearest lot line.......... _142- 6 t_ --------------- -- ------------- 011' ------------ ► ' .4f Jit a � � Remodeling and¢rre.pai'r.ing {decrse;�= �� L ---------- .,. ..�......r---------------,� ---•------------ t - ___________________________r________.______________________r.__________._______________ __ ______-_.-_______..___.______.-__ __ ________ *• _r___________- __----------------------- ------------- " --- --------------------------------------------------°� "' 1 hereby cep}ify that 1 li ve prepared +ills application and that the work will be done�tin aa4lYance with San Joaquin Coun+y ordinances, Sfateflaw.s,jand:(rules-and,'regula}io*s'aof�he San Joaquin Local Health District+. (Signed ------ ------ --------- `"�" -----------------(Owner and/or Contractor) ---- --••- • ---- gy. :(Title)- -- -------------- (Piot plan, showin size of lot, cation of system in relation to wells, buildings, etc., can be placed on verse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y .. --- --------- ------ ------ ----------------------------- DATE----------�V-/ -�` _---- - ---------------- REVIEWEDBY----------------------- ----------- - ---------------- -------- - - --------------------------------------- - DATE---------- -------- ----------- BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------------------------DATE-------------y--------------------------- -------------- Alterations and/or recommendations:-=-_--------- ------------------------------------------------------------------------------------------------------------------------a---------------- -------------------- ----------------- -------------------- ------------------------------------ -----------------•----------' ----------------------------------- ----------- -------------•-- •--------------- ------ -------- - -- --------------------------------------------------------------------------------------------------------------------------- ------- ----------------------- ------------- I PEI FINAL INSPECTION Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California