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000 FOR OFFICE USE: -------------- APPLICATION FOR SANITATION PERMIT Permit No. ...1 Z ------------------- -- ----- --- ----- ----------- (Complete in-Duplicate) ' --------------------------- -- This Permit Ex ires 1 Year From Date Issued Date Issued ________________ Application is hereby made to the San Joaquin Local Healfh District for.a permit to construct and install the work herein described. This application is made in compliance"with County Ordine JOB ADDRESS AND CATION - ' -- --•-- ----`------------------------- Owner's Name---------- r-------•--• -•--------------- ------- Phoney_--- l . Address------------ ••••. r — •�--••--•-- --------------------------;-----------------_----------------- ---------------- Phone -••------- / Contractor's Name J_ _ .. .... J�..1 ---71-7--2 -- -------------------•.---...._.. Phone..�lX..�%7��12 t Installation will serve: Residence� partment House❑ ommercial.❑ Trailer Court ❑ -Motel ❑ Other ❑ Number of living unit___ Number of bedrooms ___ ___ Number of baths -.7. Lot size ____-..__ _. .r. _Z___. -__,1___.-_ oo Community'system ❑� Private L] Depth to Water Table LO-ft- Wafer Supply: Public system) Character of soil to a dep+h of 3 feet: t Sand ❑ r Gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay O Adobe 9,,Hardpan ❑ Previous Application Made: (If yes,date---------. ---------) :No ❑' New Construction: Yes ❑ No,21Z, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: N ((No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Distance from nearest well________________Distance from foundation...................Material----.----------_-----------._.........__________- of compartments------ -------- Size--------------------1 .....Liquid depth--------------------------Capacity----------------------- osa d: Distance from nearest well 'Distance from foundation..-_10-0------Distance to nearest lot line___t�___..... r Number of lines_______I--------------------------Length of each-line___..,> ._!`_._.__._.Width of french-----sa,,_4_oC!7"-______-_---_ OddType of filter material.._ ._Depth of filter material___.___��1�____Total length__________________-0_ --------- r.. �rIle v� 1 pa Pit: Distance to nearest"well_ Distance;lfrom foundation-_0.....___.Distance to nearest lot line...... �- Number of pits____ Lining material:_JR_oSize: Diameter--- �e Cesspool: Distance from nearest-well------------------Distancefrom oundation---_.__--_:._.____.Lining material---------..___.__-____________-.___--. Size: Diameter.--- -T f -----Depth---- -----'--'-------- ----- 9 Capacity g G ------------- Liquid Ca acit els: I � Privy: Distance from nearest well----------------- ---- ---------------_____s._Distance from nearest building------------------------------------------ El „..,.. . _ v ._ Distance to nearest lot line ------------------------------------ r Remodeling and/or repairing (describe):------------------- ---- ------ -------- •----- F __________ e__ ____ _____ ____ -------------------------------r______._______ _ ________________________________________________________________________________________ -------------------------------------- -------------------------------------,,.---------------------------------------_--.---_ I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed) �R#tom- -� - �L .-�t� �----- �' --•----------- ------ r Contractor) .. . By--------------------------------------------------------- F---------------------- 40 {Ti+IeJ (Plot plan, showing size of lot, location of sys+em in relation t ells, bings uild , c. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -- ----DATE------ ---- •• -------------- REVIEWEDBY---- --------------=---------------------- - ---------------------------------- ----------------------------------------------- DATE.-------- --•---------•----------------------------------- BUILDING PERMIT ISSUED-------------------------------- ------------- -----------------'--------------------------=---------------------- DATE-------------------------------------------------------------- Alterations and/or recommendations:---------------------------- ---------------------•--' •-- ---------• ---......------- f � _ .. - Y-3- 1 --------- -------------------------------------------------------------------- 1 / FINAL INSPECTION BY:----- ------ --------------------------------------------- ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California E6.9 REY186C e•e9 F.P.Ca.7M e•613 IF