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R OFF OICE USE: ' -------------------- - APPLICATION FOR SANITATION PERMIT Permit No. ---------- - --- ---------- --- Ya - - (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 construct and install the work herein describe . This application is made in compliance with Co�ougt, i s - r, r 11�.3 n ��Ra `` °�Q` '' '---------------------------------- JOB*ADDRESS AN LOCATION _.T1-d-L 0104'---------- --• Phone-------- -----------•--------------- Owner's Name-_ _ _____ _____-- -t ----••------ -----•----------------------- ------------ Address---•--..LO--=r-� `= - -------•-------------------------- h n --•-------_M----•---_---------- Contrac+or's Name--------- --_- - ----- Phone t ❑ []. Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ W Number baths - - Lot size __ _ •------------------------------ Number of living units: ___1-_ Number of bedrooms _ 1 r Water Supply: Public system'❑ Community system ❑ Private Depth t ater Table ---_-._ ft. r feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 ❑ Previous Application Made: (If yes,date'-. .-----------1 No El New Construction: Yes [I No ElFHA/VA, Yes E] No ❑ TYPE!.OF INSTALEATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + Sep ---S©_._---Distance nromzfounSdation______- O______Material__ --------------- G No. of compartments------ _Y_ ----- Size 1 ' 1�' Liquid depth . Capacity. d� Dispo I Field: Distance from nearest well._..-_ _�_Distance from foundati __l.a___�____.Distance to nearest lot line_ f_ ----- U( --Length of each line------ --d-----------------Width of trench-A--__(__--•----.------------- Number of lines.--------3---------- -- ---- -- �� Type of filter material-_-.---__A.!_ t------Depth of filter material_-.__'f_---------- otal length_.....-Yo---------------------------- 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____________________Lining material_..____.___--__------ --- -- als. Size: Diaeter-- -------------------- -----------Depth- ------------ ---------- -- ----------------------Liquid Capacity--- ----------------- Privy: Distance from dearest well------ ------------------- - ------- - _ 9 ❑ m --- ---___Distance from nearest building----------------- ------__-.---_------- � - Distance to nearest lot lire----------------------------------_------------------------- ---•------------------ --- Remodeling and/or repairing (describe):------------------------------------------------------------------------ ------•------------------------------------ ---------------------------------- ----------------- . --- ------------------- ----- - ------------------------------------------------------------------------------------------------------------------------- --------- -------------- ------------- .. ------ ----------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health Dis+ric+. and/or Contractor) (Signed} _ 1_ ::. -- .. -� rrela,..= Tits)---------- --------- - p(Plot plan, showing size of lot, location of system ion to wells, buildin s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY I DATE_- `''f f�'6�------------ ----------------- APPLICATION ACCEPTED BY---- :---------- ----- - - ------- - '--------- --------------------------------------- REVIEWED BY- ------ ------------ ---------- ----------•-------------------------------- --- -- ----------- --------------------------- DATE------------------------------------------------ -------- - BUILDING PERMIT ISSUED--------------•------------- ----------------------------- ------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations--------------------------- - ------------------ ---------------------------------------------------- ----- -------------------------------------------------------------------•---------- ----------------------- ---------------- - - i --------------------------------------- ------------------- r ----------- ------------- ------------------ FINAL INSPECTION BY: . ___---.- -> SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California F.p.co.