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FO OFFICE USE: ------. ..._3.j'_y ...... -- �- -___. "APPLICATION FOR SANITATION PERMIT Permit No.-s/ . . f_jC..__ ------------- ---- ----------------------- ------------ (Complete in Duplicate) lee 4s _ --._.__. This Permit Expires 1 Year From Date Issued Date Issued .__.. ___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with(County Or finance o. 549 ATOJOB ADDRESS ALOC -ff -------41--- ------------------------- -------•--------------1------l-�----�--_- ---------------- dCOwner's Name----- ------ - ------- ------ -- ------------------------------------------------------ ---- ----------------------- -------- Phone- Address---- hone Address__: _________------------- ' ______________ Contractor's Name----- ------- l it Phone�r�°_�'..-------� � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _!-__: Number of bedrooms -- Number of baths Z__ Lot size _Y. X. a--•_______________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water TableS..a ft. Character of.soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application'Made: [If yes,date--------------------1 No New Construction:.Yes ❑ No X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4�4 Distance from nearest well- __ -- __._______Distance from foundation___ ______________ Material-------------------------------------------------- No. of compartments--------------------------Size---------------•------------: Liquid depth Capacity------------------- i g tion__/.&_.__.__.Distance to nearest lot Disposal Field: Distance from welt Distance of each I ned�--______________Width of trench_._.___ f" --- - --------- --- T e of filter materials.-_ _ fir_ Depth of filter material-___f&.---_�Total length_______________________ -.____ -------- Type p ' Seepage -t: Distance to near00 est well______-_--___Distanc om f ndation___. ____.Distancd to nearest lot line_________________ Number of pits-------.------------Lining material_ -.Size: Diameter__-_ .��___..Depth_____-G �_______________ V Cesspool: Distance fromfnearest well----------------- from foundation--------------------Lining material-------------------- El Size: Diameter-------------------------------------Depth-------------------------------- - ----------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well--------------------------_---------------- __Distance from nearest building----------------------------- .____.-- Distanceto nearest lot line------ ------------------------------------------------------------------------------------------------------------------------------------ - Remodeling and/or repairing (describe):------------------------- ------------------------------------- --- ------------------------------------------------- •-----------------------------------------------•--------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and r s a d regulations of San Joaquin Local Health District. (Signed] ------- -- . ---- - ---- ------------- ------------------------------------------ .......(JOwner and/or Contractor) BY----------------------•------------- -------b ----------'�- ------------ -----------------------------(Title)-----� f (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed orvfeverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY eo------- ----- ----- DATE------ ` REVIEWEDBY. i---------------------------- -------------- - ----------------------------------- --------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------- ---------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommends Dins: --___._..-.___ Y--ad,-6 � �------ --------------------------- -- --------------------------------------------------- ------__:_:_=__----• FINAL INSPECTION BY:. C6'/�= `f-_° e_-CS - - - ----------------- Date----- ----------------------------- ---------- SAN 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 r-V.C o.