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FOR OFFICE USE: - -------------------------r-r - _-i � APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- --------------------------- (Complete in Duplicate) e Date Issued -/!��-c�---�,5' --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Ho4th District for a permit to construct and install the work herein described. This application is made in compliance with County Ordi nye No. 549. JOB ADDRESS AND LOCA kI_______ Owner's Name--------btSf.1..__. tNS ----------- -------- ---------------------- Address # efM - --------------------------------------------- j p / Contractor's Name - -------- \ �1 � Phone_ tfPb_------------•�1 Installation will serve: Resident ❑ AparIm-ent House ❑ Commercia ❑ Trailer Court ❑ Motel ❑ Other r � Number of living units: Nu er of bedrooms _f... Number of baths �-- Lot size -ItQ------ _ .__-------_--- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------------_------) No ❑ New Construction: Yes ❑ No U2,-�HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank esspool permitted if public sewer is available within 200 feet.) S c: Distance from nearest well_________________Distance from foundation-------------------.Material______..____.__-______.__---___--______-._..____. No. of compartments--------•-----------------Size--------------------------------Liquid de�th--------------------------Capacity--- ----------------- D eId- Distance from nearest well.-�� istance from foundation---I.4- --.-_----Distance to nearest lot,,lfi e__-- _o.... Number of lines_._._ ____ Length of each line---_--- --_-..Width of french-.�.`�'�_e�_..__ �` T e of filter mater �. Tyle Depth of filter material _.._ Total length______________________ d S a e Distance to nearest well_. Distance from foundation------ �,t_-___.Di a cf to nearest lot line`.-_ Number of pits____._.__-._---__Lining material--t tt_C, ......_-Size: Diameter... ___..-_-Depth--__ �`___----_____._- Cesspool: Distance from nearest well__------__---_Distance fro foundation-----_--------------Lining material------------------------------------- \ ❑ Size: Diameter--------------------- ----------- ---Depth- ----------- ----------- ---------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well ______-----------_-------------------------- ---Distance from nearest building_----__--_--_-_---__----_-----------.__.-. . ❑ Distance to nearest lot lire----------------------------- ------------------•---------•---------••------------------------------------------------------------------------ Remodeling and/or repairing (describe):----`-----== -- -------- ----------------- --------------------------- --------------------- ------------------------------------------------------------------------------------------f'r- --- ----------- ----------- ------ ---------------------------------- ------- ----- --------------- --------------- -------------------------------------- - ----------------------- --- - ------------------- ------ - I hereby certify that-�,have prepared this application and that the work will be do a in accordance wit San Joaquin County ordinances, State laws, an61<.crules and regulations of the San JoaqLacal Health District. (Signed) �a� �L� Contractor gy:._29x6 E Miner Aver HO 6- 1- =-------------------- -------- --------' -----'-------------------------------------- --------- -- - - ----- ------ _(Title) ----------- (Piot plan, showing size of lot, location of system in relation to IIs, buildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.---- DATE----------- Z li 5 ---------------------- REVIEWEDBY-------------------------------- --- - - ---- ------- ------ --- ------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------- -------- -------------------- �S G- - - � TE------ ------------------------------------------------------ /I Alterations and/or recommendations:--- /A/ = -- ------------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ -------------------------------------------------- ---------------------- --------- -------------------------------------------------------- . . . ----- - -------------------------- -------- ----------------------------------------------------------------------------------------------------- ---------------------- ------ ------ - --- ---- - --- - -- - - - -- --- - 4 FINAL INSPECTION BY:----- -------------- ---------- Date_----__Z-K - --- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.