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FOR OFFICE USE: � ' APPLICATION FOR SANITATION PERMIT Permit NoA1,1-5- --- -------------------------------------------------------- (Complete in Duplicate) Date Issued 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 Ordinance No. 549. JOB ADDRESS AND LOCATION----- ---v9 Il(P-_ __ ,- --- /� ---t^ Owner's Name--------- ---1 /a..t 'L.C.17- ----------•-••-- ------ --------------------------------- -------- ----- CV, --- Phone t_ r�f Address-----•------------------------- ---- -- -• --•-•--- —f------------- ----•----- ---- ------------------------- ---------------------------- - ------------ e 0 Contractor's Na -" _ o.z-- .�. ------- -e----------- ------- Phone__444 n House L Commercial Trailer Court Motel Other ❑ Installation will serve: Residence '� Apartment ❑ ❑ ❑ ❑ Number of living units: I-_--- Number of bedrooms 2--' Number of baths _� Q ----- Lot size -- -•-Ir!----Tom---'�-'2��----------------- Water Supply: Public system gi--community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobee-_`Hardpan ❑., Previous Application Made: (If yes,date-----------:.......-) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Distance from nearest well-----------------Distance from foundation--------------------Material_________-___-.._____...____._______.__________- No. of compartments-=------------------------Size-----•--------------------------Liquid depth--------------------------Capacity----------------------- Dis al Ldp Distance from nearest well ' L0 _Distance from foundation ___._.__.Distance to nearest lot line__ ____. -------.Width of french------------•.--•------------------ ,f � Number of (ines------I-------------________.____Length of each line___ ._ - ------- \ IR dd Type of filter material________________________Depth of filfer m eriaf_________________.._.Total length_________________________________-- Seepage Pit: Distance to neare�jt wellrLQrYp------Distance from foundation_ Q_�_-_.Distance to nearest lot line___—/Q Number of pits___f-.-------_---_-Lining materiai_g� Size: iameter--11?*_;_Vf___-__Depth-ej,-------------------- 4) Cesspool: Distance from nearest well-----------------Distance from foundation--------__.._______.Lining material__._..______---------______.___._____ Size: Diameter------------------------- ------------De th---------------------------- - - - -----------------Liquid Capacity gals. Privy: Distance from nearest well___________________________________________ ___Distance from nearest building------____._________.___________.__..._- ❑ Distance to nearest lot line------------------------------- ------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (descri e):--__ ___ _____ _ ___Pa On t- ,a b r V ----- y----------------- ------ ------------------------------------------ -----------------------------------------A--% --------------------------------- --------------------------- ---------------- I hereby certify thatave prepared this application and that the work will be done in accordance with San Joaquin County ws ordinances, State la , a les and regulations of the San Joaquin Local Health District. r' �i$ E r Contractor) (Signed)---------- ------ a - --- ------ --- ---------------- ------------------- �pR'IC TANK S�RVi� By:--- 1E,-MtnerAve,�_°_l'10: •�B4t (Title)-------------- ------ (Plot plan, showing size of lot, location of system in rel ion to wells, buil ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- ---------------------------------------- DATE------------1 �f'/ r� ----------------- REVIEWEDBY------------------------------------- --------------- -------------- -------------- ---------------------------------------- DATE--------------------------------------------- BUILDINGPERMIT ISSUED----------------------- ---------- --------------------------•------------------------- ------------- DATE---------------------------------------- - ------------------ Alterationsand/or recommendations--- -----------•------------------------------- ------------------------------------------------------•-------------------------•----------------------------- ---------------------------•-- -------------------------------- -------------------------------------------- ----------------------------------------- ------------------------------ -------------------------------------- FINAL INSPECTION BY:.........P ------- Date-------- y ----------- ---------- - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi,California Manteca,California Tracy,California F.P.CC.