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�J /O 7O l YYYI//7 � APPLICATION FOR SANITATION PERMIT Permit No. ...j - (Complete in Duplicate) Date Issued _4 This Permit Expires 1 Year From Date Issued .____ _ �__ 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 compliance with County Ordin nce No. 549. f ti JOB ADDRESS AND LOCATION ��'i --Z. -----------------------------------------------------•------------------------------------------------______--_---- Owner's = ------------------------------------------ phone.................................... Address---------- �,,�----- -- --- ------ --- Contractor's Name----- -LLQ----------------------------- - ---------------------------------------------------•----•--- Phone----_---------------------------- Installation will serve: Residence 2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___4_ Number of bedrooms -e:-&- Number of baths __/ i__ Lot size -_ / __,f,t�Q_ ___________________________ Water Supply: Public''system 2_-�'Community system ❑ Private ❑ Depth to Water Table da_ ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C] i Previous Application Made: Yes ❑ No New Construction: Yes ❑ No 2' FHA/VA: Yes ❑ No W-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----__—_-�----Distance from foundation_-_ _-------Material---�` _ _--e d?A e_Z_.________- No, of compai',tments_ e_ h Z'---------------Siz �� Liquid depth- �` A- ---------Capacity----J�, 9Q--- Disposal Field: Distance from nearest�,:well,_-_—_____-_Distance from foundafion___. r--------Distance to nearest lot ._- Numbe;,of_lines-----�lX`_-..'__------------Length of each line-----QD!_-___--______.Width of trench.--.2`--,__-______________-_ Type of f_irlter maferial__L_�XQG/rDepth of filter material.-_.Z �___-_____Total length-------/r_Q_1--------------------- ____ Seepage Pit: �" Distance to nearest well-------- ----------Distance from foundation---0-T........Distance to nearest lot line__Wf-+_--_____ Number of pits--_._------------- material__ O -_-Size: Diameter__,,.;...----------Depth_ 9a---_---_-_______---__-- Cesspool: D istance from nearest Awell-----------------Distance from foundation---.----------------Lining material __-_____-___--____________________. ❑ - _ Size: Diameter---------'-;-' •-----------De th---------------------------------_ p -- - Liquid Capacity------------------ - - ----gals. Privy:' Distance from nearest ........... -,.---Distance from nearest building________________________________________ ❑ �: _ -'- art: . Distance to nearest lot line--------------------��_�_�_--:_-----�-=----_-__-- ~ `�^---_ - __ Remodeling and/or repairing (describe)----------------- -- ----------•-------------------------------------------------------- ______________________________________________________________ -----------„_.----------__._.____ y ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County " ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed)------------------- - Azli------- -- ----------------------------------------7---------------------------(ChwummijW-or Contractor) By:---------------------------- -------------------- Y� -------------------------------------------------(Tif16)- - -&e-L�--"-- ---------- -- ---- ---- - (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_------�0Z,--V-•---- -----------I--- ---------•------------------------------- DATE----- �-Z� �'�'G7------------ REVIEWEDBY-----_---------------------------- ------- ----.- DATE---------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------•------------------------ _-DATE-__".-----=---------------------------------------- Alterations and/or recommendations:-------------------------- --------------------------••--•----•---------------------------------•----•-------- ------•-------•------------------------------- ----------------------------------------------------------•------------------------------------------------•---------------•---------- a 3 �- _ .. FINAL INSPECTION BY:-- lJ ` 4`i ------ Date f�- ----- -----�=a- SAN JOAQUIN LOCAL HEALTH,DISTRICT 130 South American Street 300 West Oak Street \ .132 Sycamore Stet 814 North "C" Street } Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'S9 F.P-Co.