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} FOR OFFICE USE: ------------1° y-- ; APPLICATION FOR SANITATION PERMIT Permit No. .. ------------- ------------------------------------------- (Complete in Duplicate) Date Ilssued .tl------'2- _� ------ ------------------ 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 ins ta4l the work herein descrbed. This application is made in compliance with County Orrd��ii- ce N . 5 9. JOB ADDRESS L C TIO V ='-r'� Owner's Name-- -. PhoneY �fL � � Address---------------- ------------------------- --- --------------- ------ ---------------- ----•------------------------------•---------------------------------•---•- /� -f----- ---- ---------- Phone4.�I&_f�__�.0,7------- Confiractor's Name -------- 1�&BrP+1 Installataonrwill-serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other I$ I Number of living units: -------- Number of bedrooms .------- Number of baths -------- Lot size --- �- •r------------------- - ---- Water Supply: Public system t- Community system ❑ Private ❑ Depth to Water Table 7S77ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date_-----------____ } No �[ New Construction: Yes � No E] FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: , ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r } Septic Tank: Distance from nearest well_/V1 VP( ---Distance from fou/dation4-0-________ -Material __ No- of compartments__.___-_-__-"----Size_+K", _._...... depth__. -��-__----_ Capacityl�_��l__ Disposal Field: Distance from nearest welIA)VA) -Distance from foundation.VrDistance to nearest lot line_ Q-__...... Number of lines f lines---am- -- - Length of eaccl line______lO--- -_____-__.Width of trench-. ------- -___-_ '6 Type of filter matenal-�Cf. Depth of filter materia ____ length __ _________________________ _ � S, Seepage Pit: Distance to nearest well._ @lU -____Distance f om oundation___S _______Distance to nearest lot line------- Number __________ Number of pits -__Lining material____----Size: Diameter--3.3-'f_-_._._-_Depth--A�--- e Cesspool: Distance from nearest well-----------------Distance from foundation--------------- Lining material---------------------- & --------------- ❑ Size: Diameter-- -----------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. o y Privy: Distance from nearest well-_________________________________ __________Distance from nearest building-------___--_--________________-___-_---. j ❑ Distance to nearest lot line------------------------- -------------------- ---------------------------------------,-/---------------------------�--------------------------- I R mo elfin nd/or repairing {describe): - - -- - -------- - f "" �� Y.�XI- ��/` �+ --------------------------------------------------------------------"----- ---------------- --------- --- -- -- - ----------------------------------------------------• ----------------------------------------------------------------------------------------------------------------------------------------- ---------------------- I hereby certify that I :rule:s7a�' ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andI-egulati s of the San Joa in Local Health District. 4 ------ --- -------- (Owner and/or Contractor) (Signed)---------------------- ---------- ---------- -------'- --- - ----- Title Sy:--------------------- ( ) (Plot plan, showing siz a lot, location of system in rel ion to wells, buildings, etc., can be plat on reverse side]. FOR DEPARTMENT USE ONLY 111111111110:1 jj�, ;;l l APPLICATION ACCEPTED BY---------------- - x ---- ---------------------------------------- DATE-----------Pte__-7�07- '?� 7------------ REVIEWEDBY------------------------- - -------------------------•------------------------- --------------------------------- --------- DATE-------------- --------------------------------------------- BUILDINGPERMIT ISSUED-------- •----------------- ------------------------------------------------------------------------ DATE------------------------------------------I- -------------- Alterationsand/or recommendations----------------------------------- - --------------------------------------------------------------------------------------------------------------------- -------•--------- ------------------------------------------- -- ---------- ------------------ ----------- 4 ------------------------------ --------------------------- ---------------------------------- ------------ ------------------------------ --------------------------------------- ---- ----- ------------- �`' Date... `-----h------7------- FINAL INSPECTION BY:-------- - �� ------I- -- - SAN JOAQUIN LOCAL H1ALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Sheet Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.