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FOR OFFICE USES --------------------------- ----------------------------- - - ---_-----_----- _____- -_----_---_ 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 const uct and install the wok herein described. This,App is made in complia ce with County Ordi �- �3do NfO. SOUTH RVE� JO ADDRESS AND L ATIO ��J a � �• - ----- --- --- ------- Owner's Name----4i --------- Phone. "�tl_ Address /� L b� - -- -------- �� // Contractor's Nam -- � -- --- G f + ---------------- Phone.//Z_j -- � Installation will serve: Residenceartment House ❑ Commercial ❑ Traile Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _ Number of baths 'TrL'ot size --�A_,214- ---------------------- Water Supply: Public system ❑ Community system Private 2`15,pth to Water 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 ❑ New Construction: Yes to ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sevjrer is available within 200 feet.) Septic Ta Distance from nearest well-100-.4__Distance from. foun ation_1 &"_-_.?aferial- ------------ id depth _ ____.._Capauty.f��No. of compartments..y---___._. _.Size�.`�_��W__3�qu � Disposal F' Distance from nearest well- Distance Distance from foundation---/to?_"" __4h" Distance to nearest lot line----- r Number of lines.--. _�___-_p- Len th of each lin �� Width of trench__._��--------------- 6 *�- - 9 Z_ Type of filter material__ . DCk__._Depth of filter material_____ -___.........Total length----I_Z_Q-------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation______..__-__--_-.Distance to nearest lot line---__._.-..---.-. ❑ Number of pits----------------- ---Lining material-----------------------Size: Diameter------------------.----Depth-----------.-----.-------------- Cesspool: Distance from nearest well---------------_Distance from foundation------------------- material-------------------------------------- NA ❑ Size: Diameter----- --------------- ----------------Depth-------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------..-_-._. ❑ Distance to nearest lot line------ ------------------------------------- ------------------------- ---------------------------------------- --------------------- JC Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ---------------------------------------------------------------------•-------------------------------------------------------------------------------------- S. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------- --------------------------------------------------------------------------------------------co--------- __w.•----San--- ----------- ------ - uin------------- Jr I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lCCa��ws, nO' lgess and regulations of the San Joaquin Local Health District. 2a & / 1 4t ----- ------ - --------------------------- Contractor) (Signed)--------s>arc--�p.-r�rK--s>=R�cal�------------- ---------- --------,,- By:---.2915E.Miner Ave..=a HO.6-3841,---------------------------------- -- --------- __ --- Title)------------------------------------------ - ---- --------- ------------------------------------ plan, showing size of lot, location of system in relation to w IIs, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------TRr-&---------------------------- --------------------------------------- DATE.. Q__' I 5 ------------------- REVIEWEDBY----------------------------------------------------__----------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--_-------------- ------- -------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------- -------------------- -------------------------------------------------------------_-_- ---------------------------------------------------- -------------------------------------------- ------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ---------- ------ ------------ ----------------------------------------- -------------------------------------------------------------------------------------- ---------------------------------------------------------- -------- - ------------------------------ ------------------------------------------------------------------------------------------------------------ ---------------------------------------- --------- -- ----- . -- ------- --- ------ --- ----- - -- ------------- ----------------------- -------------- ---------- -------------- ------------------- Date FINAL INSPECT BY:. - - - - - - -�-------- - ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.1:O.