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FOR OFFICE USE: -- -�-!` 6731. -- Permit No. . _--------•-•-• Z= a a APPLICATION FOR SANITATION PERMIT ---------------------- ------------ ---- --------- -------------------- (Complete in Duplicate) ,Date Issued .... - This Permit Expires 1 Year From Date Issued - -- ------ ------ -----------------------: ------ - all th Application is hereby made to the San Joa uin Local Health District for a permit to con ruct a� rk herein described. e This application is made in compliance/4r' Gryfy/Odr JOB ADDRESS AND LOCATION ------- -!�r �,� Owner's Name-1---- --------- ` ---- ---`SS-!'�` �/�'--�'-- - .r---- - Phone ------------ Address------------•---------------- T Vx----- ------ T.rt' ---- Contractor's Name 1 -/-'.� ,�T P.�'.e--------------------- - ------------------ ------ Phone._ - �- . Installation will serve: Residence Apartment House [I Commercial E] Trailer ❑ Other Trailer Cour} ❑ Mot ❑ Number of living units: __ -_- Number of bedrooms _ _- Number of baths ---I--- Lot size _--_---.__-- / .moi '-6-�`----------- 11 Water Supply: Public system ElCommunity system El Private Depth to Water TableAo-- ft. Gravel Sandy Loam El Clay Loam Clay C] Adobe[IHardpan ❑ Character of soil to a depth of 3 feet: : Sand F-1Gl � anY No Previous Application Made: (If yes,date--_----------------) No g----New Con�truc+ion: Yes=❑ No �NA/VA: Yes El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f ---------.Material--- - �'�' ' Septic T nk: Distance from nearest well--��----Distance from foundation--�p Capacity__ ------ - No. of compartments..... . -.__Size...� '- lj- --Liquid depth- -•' -- --- -- - � mfr-~ �� r Disposal field: Distance from nearest well---_f-.�----. D�stance from foundation-.l�------•-.Distance to nearest lot fine-- ` Width of trench__-4P- ---------------------- Number of lines-----------� ----- -------------Length of each 4ine--____1f�,---/-� -- - X - Depth of filter material---/5 . - -----Total length------%�----=-------- ..l • Type of filter material.--��1�OG�_ p Distance fr m foundation__ 1 ---------.Distance to nearest lot line` _ G` Seepa it: Distance to nearest well. --- Number `' De th-. Number of pits--------/-----------Lining material- --.Size: Diameter---- _ -- P Cesspool: Distance from nearest well-----------------DDi Distance from foundstion--_.------- __---_-Liquid Capacity_...- --_-_---- .-_-----gals. ❑ Size: Diameter------------------ ------------------ p r Privy: Distance from nearest well----------------- -------------------------- ----Distance from nearest building.---________-------------- ------------- G 1016 El Distance to nearest lot line------------------------------------- ------- -------- - ------------------------------------- ------------------------- i - SCS Ir Remodeling and/or repairing describe)----------- - - -� � -- -� -------•--- -----------•----•--- ---------- ------------------ f �a : 0 ------------------------------------------------- ----=---------------------------------------------------- = ------------------------------------------------------------------------ ! hereby certify th_at'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 Heal#h District. � -.-_-.-.Own and/or Contractor (Signed) i - .- --------------- By=------------------- ------ ---- �-� �a,--------------------------------------(Title)----- E k [Plot plan, showing size of lot, location of syste in'relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ------------------- DATE----- =��=` `-------------------------- APPLICATION ACCEPTED BY----------------- --------------- ------ ---------- --------------- DATE-------- ----- -------- REVIEWED BY--------------------------------------------- ------ - ---------------------- ------------------ -------- BUILDING PERMIT ISSUED------------------------•- ---------------- ----------------------------- ----- r ---------- Alterations and/or recarnmendafiions:_----.. __ --- ----- ----- -------------------------- ----------------------- --------- -- - ----- -------- ----------------------------------------------------- Date------ -------------- `` FINAL INSPECTION BY:--------C—n-Y------------------------------ --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1 tS01 E.Ha=eltan Ave. 300 West Oak Street . Stockton,California Lodi,California Manteca,California Tracy,California