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` FOR OFFICE USE: 4 � APPLICATION FOR SANITATION PERMIT Permit No. .3 t��3 .............. ------------------ ----------------------- ! ----------- --- - .,:_------------------- ------- Complete in Duplicate) _ .„�.�::.. .,�,,:,„...--.-,, --_ _ _ - -Date Issued ---..-_----------_----__-----___- -.-_-._-_ "f—his Permit Expires 1 Year From Date Issued Application is hereby.made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application Is made in compliance withi Counfy Ordinance No. 5 9:"- jV Pi/ JOB ADDRESS AND L GA ON_.__.- . __ - -- ---- ------ ° ----------- ------- 4 Owners Name + - = ' Ghent �qQQ�� �f�asF f -------------------_ - ------ ---- - ----------- AddressContractor's Name_ ` '... .--- -- -- ------ Phone �,� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel r❑ Other ❑ _ f I �-h�1A -------------------------------- Wafer --------- Number of living units: ----- Number of bedrooms __-__ _- Number of baths , --__-_ Lot size _ ----------------- -- -- Water Supply: Public.systen Community system ❑ Private ❑ Depth to Water Table&0_ ft. Character of soil toa depth of 3 felt: 'Sand L] Gravel E] Sandy Loam Q Clay Loam ❑ Clay E] Adobe 5` Hardpan ❑ Previous Application Mad : (If yes,b ate--------------------j No New Construction: Yes ❑ No% FHA/VA: Yes ❑ No)< I'. TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if=public sewer is available Withi 200 feet.) � P � Septic Tank: ---Distance :Distance from Aarest well __________------Distance from foundation--------------------Material.--------------------------------- -------.__-__. 1, Liquid depth -Capacity p f ------Size---- q R ---------- ------------ Z,�^ Disposal Field: Distance from rnearest iE1 Distance from foundation_. Ulstance to nearest lot line:____.___. p, Number of lines Q - - -.---Length of each line_ ------------------Width of trench--- -«------------__-•.- Type tf filter maternal-- - ----- epth of filter maArial____�_�-r___.----Total length_____ "1_____________ ___ r Seepage Pit: Distance to nearest;well__ a ___Distance f m f ndation---,.7 Distance to nearest lot line- -_---. Number of its__ L nin' material-__ _- Size: Diameter- _� !� Depth ------------- NS I P Size: Diameter. ` M'NDepth` "dation Lining material Cess ool: Distance from nearest well-_-__--_-- Distance rom found ❑ f--------------------------Liquid Capacity---------------------- -----gals. Privy: Distance from near st well_____________________'_ fDstance from nearest building-------------------------------- -----El =k Distance to nearest lat line--------------- ----- ---=-------------------- ----------------------------------------------------- -------------------i-------- ----Remodeling and/or repairing (describe):-----�- :- --- -- - ----g------------------ -------------- - -------•-------------------•-------------------.--------- •---- --------------------- ------------------------ ' ------------------------------•-------------------------------------------------------------------------------,------------------------------------------------------------------------------------------------ ----- --------- I hereby certify that I hay epared this application and that the work ill be done in accordance with San Joaquin County ordinances, State laws, and r es d regulations of a San Joaquin Local ealth District. [Signed)--- - ----- -- - --- --------- ---- - ----------- ---------- - _-- --- -------------- and/or Contract ---------- --------------• Owner a or) Title______.- gY ------- ) -� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FPR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A -------- --------------------------- DATE __1 REVIEWEDBY------------------------------ -- ----------------------------------------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------- ------------------ ---------------------------- ---------------- DATE ------ - Alterations and/or recommendations-------------------------- ---------------------------------------------------- --------------------------------------- -------•------------------------------ ------------------------------------------------------------------------ ------------ ------------------------- - ----------•--------------------------------------- ------- ------------------------------------------------ ------------------------------ ------------------------------------ ----------=--------------------------------------------------------------• --------------------------- i I ------------------- ------------ FINAL INSPECTION BY:---------� �`---. _ Date - --- ,2-- .� ------------------ SAN .JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I. Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. `r