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FOR OFFICE'USE: -- ---------------- ------- --- ------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ------ -- -------------- -------------------------- ---------- --------------- ------------------ (Complete in Duplicate) -------------------4 M -----�.------ This Permit Expires I Year From Date Issued Date Issued 1031_6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiol is made in compliance with County Ordinance/No. 49. Sf p JOB ADDRES� AND LOCATION_._..!.R0 ------ ---V-001 ----------__10/ -F-..--- NIN -------0- L'i V ame__- - --------------------- --- ------------------------ --- ----�!--,-Phone'."`..- .---7-7---------------- Address--... -------- Address--....... ------- M !!;�A ------------------------------------ Contractor's Narr0� --------- ; Phone ----------------------- Installation will serve: Residence [Apartment House ECommercial ------------ E] Trailer Court [] Motel [] ,Other E] Number of living units: 4---- Number of bedrooms _'�7 _ Number:..gf baths J--- Lot size ------ 961 ----------------- 5? -WaterTable Water Supply: Public system El Community sy�pm El Priva;e eb '�th t W ;91 Character of soil to a depth of 3 feet: Sand e Gravel E] Sand Loam e Clay Loam El., Clay 0 Adobe E] Hardpan E] _PiLevious Application.Made:-(Ifdate...:,,..-_.--.......) "New Construction .- A . - , I: -yes, No Yesl _._�HA/,VA._Yes_E]_,;j_NoZ- Z;,��o El TYPE OF INSTALLATION AND SPECIFICATIONS: II (No septic tank or cesspool permitted if pu6licsewer is available eithin_.264feet.) Septic Tank: Distance from nearest well-----------------Distance from foundafion_�--t--------- -----Material------------------------------------------------- 11A , k F,)(915T7 a C-7- No. of compartments--------------------------Size-----_-------•--------------Liquid*dep.fh------- ------------------Capacity--- ------------------- Disposal Field: Distance from nearest well.---- ....Distance from fcundafioiL_.../ t----Distance to nearest lot line-___s---------- '(03Tf ------ -.Width of fren( 4Z - ---------- Number of lines---------- -----------Length of each line------170--- :h------- ---- T -e of filf yp ter material-- Depth of filter- mafle-FT1------I ---Total -length---------------- ----------------------- ?_ �` 170 Seepage Pit:, Distance to-nearest well------------ !!-!Disfant6"ff6M"lf-oun-6�Iallti0or"(-------4-)_Distance to nearest lot line._.............. ❑ ine----------------- El Number of pits------------------- Lining material------- -- -- - Size: Diameter-----------------------Depth--------------------------------- #j Cesspool: Distance from nearest well-----------------Distance from foundation__-._-__--..-_--Lining material-..-....__- 0 ❑ Size: Diameter------------ -------- ---------------Depth--------------------------------...----------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------.--------.._...-----.-Distance from nearest building------------------------------ --------- Distance to nearest lot line------------------------------------------------------ --------------------- El ---------------------------- Remodeling and/or repairing (describe):---_-.--.__. I-------------- --------------------I--------------------------- ----------------------------- ------------------------------------------------------------------------------------------------------ ----------------------I----------------------------- -------------------------------------------------I- ------------------------------------------------------------------------------------------------------------- -----------------1--------------- ---------- ----------------------------------------------- ----------------- V --------------------------------------------------------------------------------------------------- -------------- -------- ---hereby certify---that a--f- -h-have e__--prepared---____-----_----this---application---------- that the work will be done in accordance with San Joaquin County ? ordinances, State laws, and rules and e -�Ilatri'orns f=fheSan Joaquin Local Health District. -and/or-Contracf or)- —(Owner (Signed) ;r_ By:------------------------------------------------------------------------------------------------------------V---I--------------------(Title)------ ------ - -------------------------------------------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY---- fi r{ -'--------------------- --------------------------------------=----- DATE... . . . ------------------ REVIEWEDBY--------------------------------------------- ------------------------------------------------- DATE BUILDINGPERMIT ISSUED__--------------------------------------------------------------- ---------------- ---------------- DATE--------- -------------------------------------------- Alterations and/or recommendations:-- --------- ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- -------------------- ------------------------------------------------------- --------------- --- ---------------- --------------------------------------------------------- ---------------- ------------------------------------------- -------- ------- -------------------------------------- --- -------J ----- - ... ----------------------------------------------------- --------------------------------------------- -- ---------------- --------- ------- ------------------------------------- ------------------------- FINAL INSPECTI --- - ---- ------- ------- Date ----------------------------------- ------------- 4 ----------------------------------- --- ------ - ----- ............ 'T SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 324 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.