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FOROFFICE USE: —' __.. A -. . -----------//------------- APPLICATION FOR SANITATION PERMIT Permit No. __...l..Z..�a. ------ --------------------------------------------- (Complete in Duplicate) This Permit Exl2ires 1 Year From Date Issued Date Issued Application is hereby made to theSan Joaquin Local Health District for a permit to construct and insiall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND,L-BTION..___ ,Qi � ` Owner's Name t --e ' ph ------ _3.! O _6 Q --- -- Address---------=- ------A ----------- ----------•------------------------/--� •----.--�-- p Contractor's Name___ ____ Phone4_ez -_:-',,,�.Cf_T� Installation will serve: Residence Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel-0-0ther ❑ Number of living units: _ ---_ Number of bedroomi��c mber of baths -------- Lot size ---------------- Water Supply: Public system ❑ Community system ❑ Depth to Water Tablea-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p dobe Hardpan ❑ , Previous Application Made: (If yes,date____________________) No ElNew'Construction: Yes El No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted public se er,.is availablehe .) within 200 fet r l ittd if tics :{ Distance from noarest well_________________Distance from foundation___--_-_______-__._-Material No. of compartments--------------------------Size-------------------- -------.---Liquid depth------------- --- _ _ _Capacity � ros�l I Distance from nearest weil Q0---__.Distance from foundat' n_ __Distance to nearest lot lin Length of each line.. 1_ Number of lines-.__ . _�9____ „-Width of trench__ Type of filter ma '-Depth of filter material___.- _ ---__-Total length_--._______-��------_-----_---_-) See a e Pit: Distance to nearest well_�3t2-_-_-Distanc from foundation___ r ..6._--.Distanco to nearest to line___..._ Number of pits-]...............__Lining materiaLk :-_-_Size: Diameter__._33/----- Depth-----�,S----------------- t Cesspool: Distance from nearest well-----------------Distance from foundation______--------------Lining material...........__------.._.___-__--- ❑ Size: Diameter---------------------------- -- D epfih---- -------- ------ --Liquid Capacity- --------------------- ---gals. Privy: Distance from nearest.,we11------------------------___-_---- .._.--.--Distance from nearest buildingS ❑ Distance to nearest lot line _-____ ------------------- ------------------------------------------------------------------ - Remodeling -- -- - ----- - Remodeling and/or repairing {describe -------- - ----------------- ------ ref` �_ ` ., ----------------- -----------------------_____- r ------------- - - -- - - _ - hereby certify that ave'prepared this application and that the work will done in accordance with San Joaquin County i ordinances. State lawsEes and regulations of the San Joaquin Local He th District. (Signed)-------- EF'T1C �7A.1Vr –SR1l1C>=°' •------------ ------------------- - ------ ( Contractor) By:.-- 2915 I~.Miner Ave......HO:_6-3841. ,. c..g rt. - ----------=- ---- (Plot plan. showing size of lot, location of�sys#em in relation to wel uildin s, etc., can b laced on re side). 'N �? FOR DEPARTMENT USE ONLY. 11 APPLICATION ACCEPTED,BY""""'°."_ - -__--_-___ � � ' ----- DATE------�--�l�-�G - ------------------------------ REVIEWED BY `-- --------�-:_� .,..,_.-_----- --------------------------------� �-} -----._ DATE---------- � - - ------------------------- ------------ ----------- BUILDING PERMIT ISSUED-----------------------�--------- -- . --------------------------- ----------------°_ DATE a Alterations and/or re omndtionst______________ ____ r -- = 1 / ------- ------------------ -- - i r , { - - fir;= -------- ----;' ------------------- r - ---- ------ . ' ------------ ------ .{ _ _____________________________________________ Y -;_i_____________________R_____-_____...._...-_-_ .....................'_.-_--------....... ___......_-------------------------- FINAL INSPECTION BY:-_ E/ l- -- ---------- Date----------- --5 21 7 - ----------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California