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FOR OFFICE USE: t,L r Permit No. ...._ !.-.� APPLICATION FOR SANITATION PERMIT -�-1_, - (Complete in Duplicate) t�I I " "'.--_---.-:. This Permit Ex ices 1 Year From Date Issued Date ssued -_f--f-` S" Application is hereby made to the San Joaquin Local Health District for a per f vconstr ct and install the wo -befei �e trbed. This application is made.in compliance with County Ordinance No. - - - C �rf7 �w� 8 s�"�.` _,g• Ge^4 s7p ems.e�,d� � /� JOB ADDRESS AND LOCATION_ -_Q,E?'I�g,n9eiE' ------ !✓ t�ll�F 1i '�A _ K-------1_ Owner's Name �'-�E ./ -----•--- �G.L -5 �5/- --- --:---------- --------------- Phone- 7 37 'g ---------------- Address------------------------- /96 ��1�`� ----------------- ",N 1 ------------------:----------------------------------------------- Contractor's Name , /-.� � �..�--'S� �� = ------------------- Phone_ �Pl`a Installation will serve: Residence [R—Apartment House E] Commercial ❑ Trailer Court [j Motel ❑ Other E] i Number of living units: --1-.. Number of bedrooms __ Number of baths -`--_ Lot size ---------?-..-�'_ -------------- Water Supply: Public system ❑ Community system ❑ Private ❑��epth to Water Table JKI�ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ - Clay Loam ®' Clay ❑ Adobe ❑ Hardpan ❑ r� Previous Application Made: (If yes,date.-:----- .-.....) No D—,New Construction: Yes ❑ No ❑"FHA/VA: Yes ❑ No [3— '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--------- ----------_--_-.--------------------. 1 ❑ No. of compartments-------------- -----------Size----------------------------:---Liquid depth--------- - --------------Capacity----------------------- Disposal Fi Id: Distance from nearest weII_/0'0-_'.._Distance from foundation-.;A5'._i----.Distance to nearest lot [ Number of lines---------- ------- '----------- Length of each ----------------.-Width of french----er2_�-_------------------ Type of filter material--- Depth of filter material--/e....._.........Total length-_.- ----------------------- 3 Seepage Pit: Distance to nearest well-/VQ--i------Distance fr m foundation--�--.._--_-_.Distance to nearest lot line-�P",---- ER/ Number of pits------/-------------Lining material /& '---.Size: Diameter-_m_5--`-'.-.----Depth---- w�' (i i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------..-----------------_--- ❑ Size: Diameter------ ---------------- -Depth----- ----------------------------- ---------------Liquid Capacity-:-------------------------9als.a Privy: Distance.frorn,nearest well =- -r-_- -..____-_-----_- --Distance from e rest buil�dinq�----------- -------- Di - r ❑ stance to nearest lot lire----- ------ ------------ -- ----- --- ------ --- IV Remodeling and/or repairing (describe):__- -��------•-C.C�-/_-_!� - ''9 ------- --------- --•---------•------------------------------------------•-------------------------------- --------------------------------•-------------------•---- ----- I --------------- -------------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. Owner nd or Contractor Signed -- �.�,/=' --------- ---------------- ------------------ _____(Title)._ ---------------- - / Y 1 BY - - (Title)._ • +--------- - - - --�� ioca= (Plot plan, showing size of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ---- . --------------------------------- ----- DATE----- — T, IREVIEWED BY------------------------------------- ---- -- ---- --- -- ---------------------------------------•--- DATE- BUILDING PERMIT ISSUED------------------------------ --------------------------------------------------- _JDA°TE - Alterations and/or tecomme�dations f 7 .- / ` •----- �` - --------------------------------------------------------------- ----------------------------• -------------- - -- FINALINSPECTION BY:-.-- :--- ------`'` ----L-_---------- Date------. ------------- ---------------------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1 Stockton,California % Lodi, California Manteca, California Tracy,California