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FOR OFFICE U! E; �' - 7 --------------------= --------------------------------- 7-1--1 APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. ..� - -- --- 711-,%I� < -----------_—,- e� ----- (Complete in Duplicate) Date Issued --- ------------ __ ------------------------I-:----------._..._------- ------- This Permit Expires 1 Year From Date Issued Applicafion is hereby made to the San Joaquin Local Health District for a permit to construct and in all flqe work ei� descr / This ap lication is made in compliance with County Ordinance No. 549. ��r� Q�1 I-�[7,1�C�/� �7 wk, %! � T ° J. t JOB ADDRE SAND LOCA N- - ae �7`- � -�+[-c'.,...r.. -CSA ��l ? + � Owner's me---------- -----� 4'' _....... � lL/-------------- ,at-� Phone_�� " ° x.4 ---17`� & ------------------- Address_______. f L� X ----- - -------- ------- 'c� `'� ---- --------------�--- -- _ - Co#ractor's Name 1` ,•L�1 Phone---9-6-6--4.0-VI �J Installation will serve: Residence Apartment House ❑ Commercial ❑ Trainer Court ❑ Motel ❑ Other ❑ .� Number of living units: A---- Number of bedrooms Number of baths __f_-_ Lot size .� -t`�r�Vr--� " Water Supply: Public system El Community system El Private �1epth to Water Table�Qft. 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,A_ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerisavailable within 200 feet.) Suit T s: _ Distance from nearest well________________Disfiance from foundation_____________.---.Material-------_.________-_____.-.-----------.----____. No. of compartments-- ---------------Size----------- --------------------Liquid depth--------------------------Capacify----------------------- `�,, osa Distance from nearest well Distance Distance from foundation --- to nearest lot line_ I Number of lines___._____ ____ ______ Length of each line- i i_ _ Width of trench__/__.___�_____.P________ /fi Type of filter material�olll� ___Depth,of filter material---_1__ Total length_____________ �_____________ _ - `d ��- -.___ Distance to nearest lot li e Seep? e Pit: Distance to neare t well_ �?___.'__.___Distance��yyfrom�� foundation__ _ ------ Number of pits.__-----------------Lining material-_� ll;----.--.Size: Diameter_53-f f___.Depth-- re �_ __.___..._..___ Cesspool: Distance from nearest well-----------------Distance from llfoundation.. ...............Lining material----------------------------__---._. ❑ Size: Diameter--------------- ` ---------------------------- -------------------- -Liquid Capacity----------------------------gals. Privy: Distance "from nearest well,_.___.-—------------------- -_-._.----Distance from nearest building.--------------------------------------- [� Distance-fa n areO- of line r' ; ng (describe): „ ` - - - -------------- "- ----- -------------------------------- Remodeling and/or repair ^ - - -- "---- --- i -------- ---------- ------------------------------- -------------------•---------------------------------------- $' ------ -------------------------------------- ---------------------------------------------------------------- --------------------- -----------------------•-------------------------------------------------------------------- «R ! --------------------------------------- '`-------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- °'- I hereby certify-the t-l�rheye prepared this application and that'the work.will6e.done in accordance with San Joaquin County ordinances, State laws, a ules and regulations of the San Joaquin Local Health District. �a (Signed)-------S-EPTEC- T"AftK---.9kfZV E1------------------------------- ¢ '�' Contractor) 1 2915!; Miner.Ave. • k10s636�411 !-_ By:-- '-----------------`---------------------------------- -------------------- ---- -------- (Title) ' (Plot plan, showing size of lot, location of system in relation wells, building etc., ce�,Le placed onreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------- -------- ------'----- --------- DATE------ --- -71-- --- --------- r~--- ' __ .... ------- --------------- --------------------------- DATE------"------------------- --------------------------------- REVIEWED .BY---------------- -- --�-�--�-�------� - - BUILDINGPERMIT ISSUED--:----•---- - -- ------------------------------------------ --- --------- -DATE----------------- -- �,-- :---------...----- ------ Alterations anal/or recommendations: I- -------5----•---------- � -----'"7 .ate == - .-------` -----t '-r 0-4 --------------------"---------------------------- ------------------- ------ ---------------------------------------------------------------------- ----------------------------------------------------------------- F II 1 13= FINAL INSPECTION BY:--� --- ------------- ____1 Date --------------- -- --------------------- - ) SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxetten Ave. 300 West Oak Street 124 Sycamore Street 205 West 4ti,Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CC.