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FOR OFFICE USE: -------------------------------------------- _----_--------------------_-_.-------..---.---_- ... APPLICATION FOR SANITATION PERMIT Permit No. "(Complete in Duplicate) Date Issued ---------------------------------------------------- - This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health District for a permit to constructand install the work herein described. This application is made in compliance with County Ordinance JOB ADDRESS AND L CATION_ ."'- :. r � �46� Owner's Name-------------- -- --------_------------_ a- `--------•----------- Phone---.--.------•-----=---•------------ Address._ > { ------..........•---- ----------- IZI Contractor's Name -- --- J ---•------- Phone----•-•--------•--•----•----------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -./_- Number of bedrooms-_- ;Number of baths .2--_ Lot size .t---------------------------------------------- Water Supply: Public tsystem E] Community system MI-Irivate 0 Depth to Water Tablea,0_s ft. -4 Character of soil to a t,depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe &- ardpan ❑ Previous Application Made: {1f yes,date--------------------I No ® New Construction: Yes Wo-No ❑ FHA/VA: Yes [1- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer` is available within 200 feet.) Septic Tank: Distance from nearest ws�ell__ �_ ��t��/�-Distance from f�ndation_./ - 9] _� No. of compartments_a--.------I...._...Size_ Liquid d 'th..��_--_ ----------Capacity/"Q------ Disposal Field: )Distance from nearest wel!_IIPf..._.Distance from foundafiion-/e.. ___-'- .-Distance to nearest �t line_ _.._____ `Number of lines------ Length of each line_!W--�--- Q'-____.Width of french-,2------f______-""--_.----___ i Type of filter material- / f_�_.Depth of fiiter material-______.__,_---Total length-�r��__----"-_-----__ _- Seetear t: Distance to nearest l�well_!___ ____�Distanc`Distance fon anon_-.�l°`._.-".__.�Di"stance to nearest lot line_tmf____�.___ Number of pifs.._.tt11 ►__./-_____Lining_material_ --.Size� Diameter_-(Q .._._.Depth_ ._-_-_" _____________ Cesspool: Distance from Weary ew�dl! Distance from foundation-------------------- material-----------------------+_-.___-"._". Qv ❑ Size,-Diameter._---` --------------- Depth - - - ----------------Liquid Capacity-- ------- ---------9alsC _ Privy: Distaric om nearest well-----------------------------------_____________Distance from nearest building--------------_____.-._._____.._...__..._. _ ❑ Distance to nearest lot kine -------------------=---------------------------------------------------------------------------------- Remodeling and/o pairing (describe):------------- = 5 ----- -----------------•----- --------------•--------- r ----------------- .. -------------'-------------------------------------------------------------- - --------------------"------------------ ----- --- ;. _________________"-"_--....----_-__ ._____."-.-_.-._.__-_-_._"._______-----_____-__-_-__---_-_-_—-___-____-------___-_______„__----__-_---"-_-_--------_--___..--__"-_____-___._"---__-_-___-_----------._------_.......... l I hereby certifythat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San}Joaquin Local Health District. r (Signed)------ -----------------f -- ----- r Contractor) Title _-- !' (Plot plan, showing size of lot, location of system in relatio wells,, buildings, etc., can be placed on reverse side). 'I,1 , . # f FOR DEPARTMENT`USE ONLY APPLICATION ACCEPTED BY_____ - - - - . -- =-------------------------------- DATE---NA-13-1 - ----------------------------- ' � - � - REVIEWEDBY------.I ----- -- ----- ------------•--------------------------- ------------------------------ DATE-------- --------------------------- --------- -•------- BUILDING PERMIT ISSUED-------------------------------------------------------------`---------- DATE A t rations and/or reromrrkend tions: _ _._ '_ _ - ' _:--- - ---_ ----- ----------------•- -------------------------------- _-_-::_ :_______::________:________ a _--- --- -------------------------------------- - ------ --------------------- ------ ---- -- --------- - ------ ------- ----- . ►. ----------------------- ------ - FINAL INSPECTION BY: -------------------- Date $ ��5 SAN JOAQUIN LOCAL HEALTH DISTRICT �% {v 1 \-' 1601 E.Hoxellon Ave. 300 West Oak Street 124,Sycamore Street`s 205 West 91h Street Stockton,California Lodi,California Manteca,California t Tracy,California F.P.ra. t