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S FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. / _ --- -� �'E--------- (Complete in Duplicate) -------------------------- -- - - Date issued .---/7-3./ 5� _-------------•.... ... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit constru and inst Il the work herein described. This application is made in compliance with Cou ty or No. 5 9. � . JOB ADDRESS AND QCATI N--- ---- - -- ,2C _--------- - t ° Owner's Name..... �� Phone --- - -- ------ - -- - - '-' --------------------------------•----•------------- Address-------•---------------- --• -- ` Q - ---- - - � - _ - -------•-----•-----•--- E� z Contractor's Name-- k"�= ` - --------- 44T 44T------ -F.�-��. Phone-W- --V Installation will serve: Residence Apartment House ❑ Commercial ❑ Tr�a le ourt ❑ Motel ❑ Other ❑ 7 / / -- ------ u&Number of living units: -"-.__-" Num -of bedrooms 6�__- um er of baths "" Lot size,--- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water(T abler____"''° ff:' Character of soil to a depth of 3 feet: Sand E] Grove[ [I Sandy Loam ElClay-L oa'm`❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (if yes,date---------------_.-•I No ❑ New Construction: Yes No.No FHA/VA: Yes E] No E'] f TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feetI e Tan .--Distance from nearest well-------._--------Distance from foundation--.:` _.-_-"--__.Material----._."----------------":.--------_-._-_-.-"" No. of compartments_ -- /D stance from foundatiolQu�d depth--" Capacity-_."___________________ - --- - I �f F Distance to nearest lotjline--"".'-' ��e : istance from nearest well--9r.�11 1/��--------- --"---umber of lines_-_._ __ Length of each line-' "-6-.__------`----.Width of tren !_�--------- ----- . 4c Type of filter materialtt"� __"Depth of filter material._.�_��-_.._---Total length-_ _t7-- ------------------- - �/ ! �---- age Pit: Distance to neare twell- ` ---- --_--Distance rom foundation---_._ Distance to nearest lot line--.- (� Number of pits---- ----------------Lining material_ r T_.-1_.Size:4Diameter-0.511F--- --Depth_._j_�---�---------------Lining material-------------�--"._essiioofrom nearest well_____----".____-_Distance fromundation..-.-.-E.-_-_-._-. ------------ ❑ Size: Diameter----------------------- ----- - ------Depth_---------------------------------- - ------------ Liquid Capacity gals. .,,,,,. Y� Priv Distance from nearest well---------------------------------------::------ -Distance from nearest bui4ding--------------------------------------- ❑ Distance to nearest lot line--- -------------- --------------- -------------------------------------------------------------------------------------- -------------- -- - Remodeling and/or repairing (describe): --------------�----------------------- ------------------------------------------------------ - A-------------------------- ---- ---- -- ----- f �-�� ''------------"_------ F ' ° - ----------------------- ------ ---�-------------------------------------••----------------------------- "� 1"hereby certify that I have prepared this application and that the workVl.)�, one in accordance with San Joaquin County ordinances, Statef1s. and rules an egulations of t e San Joaquin ocal District. l� ontract { Signed) - -- -------- ------------or r C or[ ---- ------ is -- -- - (Title) -----------------------•--- --- a------ - ----------------------------------- - -- ------------------------------------ - ,[Plot plan, showing size of lot, location of system in rely+ion wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i .r— APPLICATION ACCEPTED BY--- -A— :? ----`-------------------- `Z= ---------------------------------------- DATE-.- y REVIEWEDBY---------------------------- - --- ------------ - DATE----- ----------------•------------------------------ BUILDING PERMIT ISSUED----------------- - ------------------------------- i ------- ------------- DATE------------------------------------------------------------- - ,, 4 Alterations and/or recommendations:-------------- -------- ----------------•------------------------------------"------------------ ---------------------------------------------------------- ------------------------------------------------------------- -------------------------------------------- ----------------------------------------- -------------------------------- ------------------------------ --------------------------------------------------------- ----------------------- -=- - ----------------------------------------- FINAL INSPECTION BY:. .----rNJOAQUIN -- --------- Date1-..-- ------- LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3 . treet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.EO.