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FOR OFFICEFUSE ------------ ----- - ------ ------------------------ --------------------- APPLICATION FOR SANITATION PERMIT Permit No. / .... ------------------------•- ----- --------- ------------ (Complete-in-Duplicate.[ ; _..__ This Permit Expires 1 Year From Date Issued Date Issued ----- -------- -- ----------------------- 2-0-5 - 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 complia,nc wi;14X-ounty Ordinance No"549. TLf� ADDRESS AND LOCATIO _��_DL--- �1 --- ----- -- �� ----! v- -?1r----- 111-------------------------- JOB Owner's Name--------------- Vole-1k. ----------- HARP---- ARP--•------------------------------------------------ - - - Phoneli •----------- ' 'V -------------------Address-----------------------------B_T:�----•-----[--- --------- - X--------V-7 ------------- ---- I-•-- ---- Contractor's Name--------= E-----•----------------- ----- ---- --- -- ----- -------------------`------- = -------------- Phone_----------•- ------- Installation will serve: Residence F�t' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I� Number of living units: I------ Number of bedroomis _� Number of baths ____If___ Lot size ��_��_�T�_________I------------- Water Supply: Public system El Community system ❑� `.Private W9-"_D_epfh to Water Table 15- 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 E] No [Tr"FHA/VA: Yes E] No T-Y-P_E..OF,INSTALLATION_AND-_SPECIFICAtIONS: [No septic'.fank or cesspool permitted if public sewer is available within 200 feet.) „ Septic T nk: Distance from nearest wek__45'6-------Distance frqrn foundation-- --- Material.... C_[1' _T---_______- i No. of compartments----- ---------------size_ :S__-_::___Liquid depth__ CapacitY._,__ -------- --Disposal Field:.. - Distance from nearest well-_,50-_-_--_Distan'' z dation __________-Distance to nearest �ot line ___�___.___ Number of linesL *eiklne_-_— entof trench.---:;Gj-------. 1 N� Type of filter material"_ G._ K-_-Depth of filter materiaL____� ___ g ------------------- AI - -Total len length :`------------ El Number of its----------------------Linin material--------__._"------------.Size: Diameter-----------------------Depth-----------------•- Seepage Pit: Distance to nearest well________--------------Distance from foundation____ Distance to nearest lot line____: - Cesspool: Distance from nearest weld_ _"___.___+' Distance from foundation_.'_---------------_Lining material------------------------------------- „ ❑ Size: Diameter-------- ----- p ------Liquid Capacity--------------------- -----gals. Privy: Distance from nearest well-------_......._-----------_---------------------Distance from nearest building-------------------------- -- '�.._-_____.-. ❑ Distance to nearest lot line---.-1'-------------------------------------- ----------------------- -----------------------------------------------------------`------------ Remodeling and/or-repairing (describe):--------NE-7ta d_6--------- _k_ 't1_ .--------SyS77a - -------------------------- 'p1------------- 4 s + it I -------___--------------------- I hereby tify That I have prepared this application and that the work will be done in accordance with San Joaquin',Counfy ordinances, a laws, and rules and mations of a San Joaquin Local Health District. i (Signed) ; --------- -------- - C-- -- i----- - (Owner and/or Contractor) fp By:---- 'I� ------------------------------------ --------- ---- ---- --- y:-- - - - ----; --- �' .... 11 (Plot plan, showing size of lot, location of system in relation to wells, buildings, ete.,%can',be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y._ -_ __-l-.___ _.- -- - - _-- ----- -------------- - ---------- ----------------------------- DATE .!.l•` I --- - DA•TE� - ------------------- - - REVIEWED BY----------- --`=---- ---- ------------ ---- ------------------------------------•-•-=----------------=---------------------- ---------- BUILDING PERMIT ISSUED----------------'- --------- - :-- �, -. - - ---------------------------------------------------••-------------------------- Alterations and/or recommendations:------=---•----------------- - - ---- _..---------.-------------------- --------------------------- --------------------------------- ---------------- ----- -------• - - ---------------------------------- ----------- ------------------ -----'- ----- - - ----------------- ---------------------------- -- - -- ------ - FINAL INSPECT1f -B '�`!r ---� ----= --- - .... _ ---- Date_ 11- -__A� __.-- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street. 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California- Ik I i r