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FOR;OFFICEASE: 21 -------------------------------------------------------- ----------------------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. -_IY.:��--1---. (Complete in Duplicate) s. Date Issued --- --�d--�-�--5 i _..___________________._--..-.-----------_----..-_-__. This Permit Expires 1 Year From Date Issued I - 2-`f It- 0-os Application is hereby made to the San Joaquin Local Health District for a permit e o construand in#all the ork rein dj�aribed. This application is made in compliance with County Ordinance No. 549. � Z o :3 0. JOB ADDRESS AND OCATION -4 —• � �Y= =tEr..`.- Owner's Name-----. �h'z---.-__ � --_- Phone- ' ---- ------ - Address.-..------�� '`.`. �`!`� � ---t----- ----------------------- ----------.------ - - - ---- - ------------- ---- -------- - v Contractor's Name. --- �-- ---_ - --- ' Phone_ Installation will serve: Residence W4partment HouseCommercial E] Trail r Court E] Motel ElOther ElNumber of living units: _ ______ Number of bedrooms_ Number of baths—Lot size -----7_. �^ - ' Water Supply: Public system ❑ Community system ❑ Private &_61--p"th to W ter Table -------- it. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ CLay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------) No ❑ New Construction; Yes No ❑ FHA/VA: Yes ❑ No ❑ .: . TYPE OF INSTALLATION AND SPECIFICATIONS: .J (No septic tank or-cesspool permitted if public sewer-is available`withind-200 feet.) � � '"""- VVr Se tic Tank: Distance from nearest �jelle_...--Distance fro ou anon___________...Material--- _! _ _____ _________ __ _-----74 . No. of compartments__ F-------------------Size_�i�__ _ __- - ffSquid depth__ ..�r..._._._Capacity:�. f _______.2. f- P -e- . . Disposal Field: Distance from nearest well. .Q.-_ Distance from foundation__ istance to nearest lot line___. Number of lines... __- Length of'each line-___ '__:'_____:__.Width of trench_x ��----------------- t - , ` �C De th of filter material-_f_��'_�� otal length___.-_/ 70__ ---------------- -------- i Type ar filter material_._� p Seepage Pit: Distance to nearest well-------------- ------Distance from foundation----------------- to nearest lot line-_._-.----_--...- ❑ Number of pits----------------------Lining material----------------------"Size: Diameter..-------------------.Depth---------.---------------------- t • 1 - Cesspool: DiOance from nearest well---_-.---_------Distance from foundation.................:..Lining material------------------------------------ 171 -_.._. .___.-_-_-_----.------_=`❑ Size: Diameter------- ----------------- - -- -------Depth-------------- - °------------------- --------Liquid Capacity------------------------------gals'.. , Privy: Distance from nearest well._..--__-.__.__-______-----------------------._Distance from nearest building.__._.._._.____._._._.__._._.____._____. ❑ Distance to nearest lot line ---- --- -------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------- '' I ----------------------------------------------------------------------------------------------------------•----------------------------'--- ---=------------- `-------------------------------- ---- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----- I hereby certify that I prepared this application and that the work will be done in accordance with San Joaquin County- ordinances, State laws and x and regulations of the San Joaquin Local Health District. r_ Contractorl£ (Signed)------------4sr �rfe -r-ft�tfc sElvrc --- - p,,,�- .BY: = 2915.E Miner.Ave.a'I�0�6�3847E --- ---- .-- --- - ----------------------- {TItIeJ__ } (Plot plan, showing size of lot, location of system in relati to wells, buildi s, etc., can be placed on reverse side)." FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- _ _. ------------- - ---------------------------------------------------- DATE--------- ----- - --- REVIEWEDBY------------------------------------'- --------- ------------------------ --------------- ----------------------------- DATE-------------------------------- BUILDING PERMIT ISSUED-----"' ----------------------------------------------------------------------------------------- DATE-------------------------------- ---------------------------- Alterations and/or recommendations:------ ----------------------- ------ - - --------------------------------------------- ----------------------------•------------------------------------r- ----------•-------- ---------------------- ------•-----------------------•-- ---------------------------------- -- ---- --- --- - ------------------------------•-------------- ------- ------------------------ --- ----------- ----------- -------- -------- ----- --- - -------------- - ----- -- -------•------- ---------- ------------ -------------------------- ----------------------------------------------- t' FINAL INSPECTI BY Date----------- / J $ SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes!9th Street -.ate Stockton,California Lodi,California Manteca,California Tracy,California r.P.CO. T 7 .