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IUK 0-HCE USE: -- ------------------- --------- ------------------ ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .4.-.a- _ ----------------- ------------------------ -------------- (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health Dist ' f a,,,,pp��ermit to construct and i the work herein described. This application is made in compliance with County Ordinance No, (� �� JOB ADDRESS ATION- --- ---- ---- -----"-Z Owner's Name------- ---------------- ----- ----- Phone-------------- Address--------- �---------- - ti Q -- - - --- - ------------ ------------------------ Contractor's -- - Contractor's Name ---••---••------ ----•-•------------------- �_�.�-AN_ �5.__-3Q_O+----- ------ - ---------- - Phont Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailr Court [Iotel E] Other E]Number of living units: _1_.._ Number of bedroom,____ mber of baths _i__ Lot L size ___ . r Water Supply: Public system ❑ Community system Private ❑ Depth to ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ElNew Construction: Yes to ❑ FHA/VA: Yes AIo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septi Tank: Distance from nearest v ll W Di �;�fro -ffo.un• •ons __ �"• �"""`^'" "�" �/ Mteria- ----- - ' No..,of,compartments 5iae --X- Liquid deptha� _ - -. - ---Capacity(-.7---I----- ,. i ! Disposal Field: Distance from nearest: elDistanc�efrom foundation___________ _ D's T o nearest lot line_-___F________ Number of lines- _`-. Length of each line p_ dt o french__ _. -,__fr _ Type of filter materia.___... _ _ Depth,of filter material_________ _-Fr___Total len th__ i t _11- �,�•,,,,, "i P ' , ` qL, 9 1 - - ,�„-__��;D:istanee to nearest lot line_._____-;_..___.. Seepage Pit: Numabere of -ft rest--� ------- ini6 m©teriaLe ----V�found5ize Diamefier---------------1-------Depth----------------- ----- -------- Cesspool: Dista to from(nearest well__._-_.___�.-___Distance from -oundati ________________ __ Linin I ❑ Size: Diameter.-------------------------------- material- ----- ----------i -- :-- �.�� t_ Depth__ _ --- _ - -- `' :Liquid-ACapacify 9afs.� S Distance from nearest ---------- w- Privy: ell__ ............ Distan e from nearest'building� ti -_---- •_. g-- ---- .� ❑ Distance #o nearest lot line-------------------- Remodeling -----------------Remodeling and/or repat{n9 (describe]:---- ' ��_'' = ------ ---- . , -------- ------------------------------------------------ ----- -------------------------------- -- -------- ____________________________________ ------------------ ' __ "' ------------------------------------------ ------------------- ' ------ ` { ! ------------------------------------------ I -------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Stat} la s, and rules a regul tions of fheSan Joaquin Local Health District, i t W (Signed) ---- - 't �'- 6 By:----------I;----- ------- ------- -=----- ------ - Title r' ntrl --- { { - ----- ---- --- --- --- - -- {Plot plan, showing size of lot, location of system in relation t el building etc.,'can be placed on reverse side). , I ----------------------------------- FOR DEPARTMENT USE I NLY x APPLICATION ACCEPTED BY--- x.l' --� ---------- ...................... ------ DATE--------- REVIEWED BY - `` --- -------- DATE # BUILDING PERMIT ISSUED -"------=�------=--- = '"'------------------------ DATE Alterations and/or recommendations:._.____.___ "- - t•;-, ---------- - --------------------- -------- ” ; ! w ____._.___.r_______________ __________________________________ ________________________________________________ L ------------------ " ------ ----- FINAL INSPECTI Y:. ------ Date-------- -•--------- -------------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT [ 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy,California F,P.Co.