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FOR OFFICE USE: ----------- -------------------------------- Permit No. 1...3. it APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued-- -------------- ---------------- ------------------------- --- ... .._...._ ,-.. _ - ---:_------ ---- - - - ----=--r.___ This Permit Expires 1'Year Frorrti Date Issued Applica#ion is hereby_made4o the San Joaquin Local Health District for a permit to construct and i all the wcYrk herei wdescribe j..v. . .., . Y.4, .-- _ .¢ This applicafion Is madeiin compliance w�tli C'o"urity-O rdinance'No: .__ t JOB ADDRESS AN CATION - a f s l�, - ale Owner's Name--- -- ------- �� _/U_ '. ` -------------------------- �� Ph e_ g X .� ---------------------------------- ----Address----•---- ... --- (-- -- G Contractor's Name------- ---- r •- Phone -Z- . Installation will serve: Residence �.Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo#e; ❑ O h ❑rfNumber o� living units: __�.___- Nmber of bedrooms _ ___ Number of baths _ � Lot size -A _-- ______. ��- ------------------- r t R i t: �' Water Supply: Public system' C Immunity system ❑ Private K Depth to Water Table ft. I r Character of Soil to a dtepth of 3 feet! Sand IO Gravel ❑ Sandy Loam ❑Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made (If yes,dte-__.___-.- 'No New Construction': Yes E] No'�. FHA/VAYes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: -�-�(No-septic tank arcesspool-permitted if-publicsewer-is-available wt+hln 20 ).�-- ,. - ------ Septic Tank: ,, Distance from nearest well----:---------'__-Distance from foundation__:______-----------MateriaL_�__�__� _-.-_________-_ .__ ❑6)CI5 {�IvCNo.`ofIcompartments--------------------------Size-/" ,« Liquid deptk�� Cap ci#Y ti or l� = q�, "..Dlstance*to�eardst lot li=_-`-v------- P e, rom nearest �well.,X0.0__._Distanee. from-foundation_: - Disl Field: Distant Number of lines--- Lengfih.;:ofeach,line- ff _ . -- It Width of tre�ch___._. r_-_-___ ._.-___._- {�QJr Type of filter material- Dlpth'of filter materia ------Total length°_.___= -- YP� � '�i Seepage Pit: Distance to nearest well___________________-Distance from foundation------------------Distance to nEares# lot line_____- _______-. ------De th l ❑ Numb �r of pits--- ----------------Lining maferial----------- -----------size: Diameter---- #P a 1 Cesspool: Distance from nearest well_______________ Distance from foundation_-_-_----____ _--__Lining material_'._-, ____-_-________.-_______-..- ❑ Size: Diiameter------ ----------- -- ---------------Depth--------- ------------------ ---------------- -- Liquid Capacity gals. Privy: Distance from nearest well_______________._--___--------------------.------Distance from nearest building.,-------------------_-_----------------- ------- C ❑ IDistance to nearesf lot line------ -- ------------- - ------------------------------------------- --------------------------------------------- ---------------I Remodeling and/or repairing {clascribe):----- - --------- ----- ----- --------------- --•-------------•-------- W ------------- wd�4, �- I ' II ---- -----------------------=-------------- --------------•---------------------------------------------------•------------- } - ------------------------------------------------------------- ------------------------------------------------------------------------------------------------- -------- I hereby certify that I ave prepared +his applice+ion and that the work will be done in accordance with San Joaquin County ,ordinances, State laws, d ule.-a-nd regul ions of the San J quip Local Health District. {Signed (Owner and/or Contractor} 9 } -------- rh --------e j _ -.__=� c__ ---------=(Title) -_ �_---- ------ - = _ (Plot plan, showier size ofiro+,_location?of system_in relation +o wells, buildings, etc., can be place on reverse side). 1� FOR DEPARTMENT USE ONLY` �M c APPLICATION ACCEPTED BY.-.-- js [y DATE `. ---------------- FW_ / DATE REVIEWEDBY----------------- I------------------------ ------------- ------------------- BUILDING --- ------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------------------------------------------------- DATE--------------------------------------------------------- Alterationsand/or recommendations---------------- ---------- ---------- - ------------------------------------------•-----------------•--•---------------•----•--•------------------------------- k --------------------------------- -------------- I� ----------------------•-------------------- -----------------------•--- --------------------------------------------------------------------- ---------------- ----------- ----- ------•------------ ---------•----------------------------------------------- I" C'S S' air fi ---3d— .�------------------------------- FINAL INSPECTION BY:_._...-. ___-.- - i A✓s, S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California F.P.co. .