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�_- ---------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. .__. ---------------------- --- (Complete in Duplicate) '�� "'`��5 -- This Permit Ex fires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District / This application is made in compliance with County Ordinance No. Date ssu for a permit to construct and install the work herein described. JOB ADDRESS Al , ` ATION._ 1 �L--- :i r f I ------------ - O• ---- Owner's Name- -_-.�_ =_--?�K,-_-.---"- - ---- --- --------------------------------- --------------------- Address ---------------------------- ------- Phone ---------- Contractor's Name__ -moi_ - Installation will serve: Residence � ' artment House Phone. - / ❑ Commercial Number df living units 1--__- Number of bedrooms ❑ Ira, r Court ❑ Motel [] Other 1 Water Su - .,...'— -- Number of baths ,_j----_,. .,_ Supply: Fublic system ommunity system "' ^.___•, Lot size ___. -_ I s r . ..,.- .7f ---- 1- . Character of soi� to a depth of 3 feet: Sand ❑ Private ❑ Depth to Water Table _ t . ...... .. .... } Previous Application Made: ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ,� (If Yes,date--- -- -- --- ) No ❑ Clay ❑ Adobe L�'I-iardpan [] i TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ New Construction: Yes ❑ No t' (No septic tank or cesspool permitted if public sewer is av ' HA/VA: Yes � Ivo ❑ Se T � _lyithjn,X00 feet.) s Distance from nearest well_._-_____- ____Distance from foundation__._ No. of compartments--_ _ -_"_-- Material.. i ----.-Size------ -------------- i ispos I Field: Distance from nearest well ""--- -- -Liqui depth__-_ i - --------Capacity. I Number of lines----I Y � -0istance from foundation.__ � `" Q Distance to nearest lot line--_- 4- Length of each line_--- Type of filter materia' _-- Width of trent s` l ----- Se e Pit: - -�- epth of filter material-- X_- ` Distance to Weare twell-- - �� --- --------Total length-"---------------------- � Number of itsl wa1 -_-Distance ion- 3 �s -- - --Lining ma#eria --� c�ation_ y l p P -----___.Distance to nearest lot line_ / Vl Cesspool: Size: Diameter- Distance from nearest well__"________ ' #ante from foundation-_-_-___- ---- Deptn_-,� `i Size: Diameter-- ------- De 'th - _Lining material_ Privy: F El Distance from nearest well -__-__- 11 -- Liquid Capacity ? ---------- _- __Distance from nearest building Distance to nearest lot line ___ __ ----gals. --------- Remodeling and g --t ----- ------------------- g or repairing (describe: -- ------ ------ - -- •-a -.---- --- - ----- ---- �i -------- ------ ----- ___ ------------ --- ------ hereby til�ify#katl h ie p�ej�eiccf fhis' appyication' "ET�fliaf the wo k will be done to accordance with-S - ------)--------- ordinances, St f la s, and les and a ulations of the Sa Joaquin Loc Health District, - • an Joaquin County \\ (Signed)_ � ! N etq _ or Con+racfor) (Plot plan, showing size of lot, location of system in relation to 9 , (Title)--- ----- -------------- Is, buildin s c., can be placed on reverse side). 1FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- REVIEWEDBY------------------- ------ ------------------- ------- BUILDING PERMIT ISSUED - �-"- ------------- - -------------------- Alterations and/or recommendations:_ c TE f' ----------------------------------- - - ------------ --------------------------------- {� ---------------------------------------------------- - --- ----- - - - - - - ----------------- FINAL INSPECTION BY: __ 1 ---- Date-. - ______ 1601 E.Hazelton Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California 205 West 9th Street F'P.Ca' Tracy,California