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FOR OFFICE USE: ------------- c_-.-_________-7,j_v_ APPLICATION FOR SANITATION PERMIT Permit No. . -,94 �r -----------------------------------------------------/ - (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 described. This application is made in compliance/with County Ordinance No. 54 - V,. �JOB ADDRESS AND L TION----/__- ---- -------� -- &,e�- ----------------- -b--- -------------------------------------- � Phone'¢ _ .. sOwner's Name-------------- d7dl------- -------- -------------------------- Address ------------------------ Address-----------------•-----------170 &--•----:5,----- ---- �-----------•----.----------•--- -------------------••--•--------------•------------ Contractor's Name-------- ------�. - els!.-.... Phone.. ..... Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/-- Number of bedrooms --L Number of baths ._//-'"Lot size ----/P__a-..l---- -------------------------- Water Supply: Public system X Community system ❑ Private ❑ Depth 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 Z New Construction: Yes ❑ No 0 FNA/VA: Yes ❑ NO'K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material---._-.---_-__.-.-.---_-----____----------_.---_. ❑ No. of compartments--------------------------Size------•------------------------Liquid depth---------- - ----------Capacity--•-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation----------.--------.Distance to nearest lot line_--_.__-__--_____ ❑ Number of lines----------------.------------------Length of each line------------------------------Width of trench_-._.-___--_-___-_._.____-__-_ J Type of filter material------------------------- of filter material ._.---------------_.--Total length-----------------------------__._--___.- Seepage Pit: Distance to nearest well----------------Distance fro foundation-__�Q_-----.Distance to nearest lot line--Z ...... W [� Number of pits----------/_..__.Lining mate ria l-_,��ieb-0-(Size: Diameter__�.�-.-----------Depth---------`---._------- Cesspool: Distance from nearest well-----------------Distance from foundation--------.-----------Lining material_.__--------.----.__--.------------. U ❑ Size: Diameter--------------------- ---------------Depth---------- --------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_----------------------------------------------Distance from nearest building------------------------------------------ 0❑ Distance to nearest lot line------------------ -------------------------------------------------- ------------------------------------------------------------------- Remodeling and/or repairing (describe):-------l-ITQ------j6;'.K __a�._.-.-._. ---------------- � A ------------------------------------------------------------------------------------------•----------------------------------------------•------------------------------------ --------------------------------------------- -- --------- -------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an ations of the San Joaquin Loca a istrict. Di_ . - --- --- -- -- __R!---� `5� f/-- - - 'r�S------ nd/or Contractor) (Signed) By:--- -----------------------------------------------------------------------(Title)--- - a --- ---- -------- (Plot plan, showing size of l�Iat=onosystemin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY----------- =' �.�' --------------------------------------------------------- DATE---------- ��=-�_/-_16---------------------------- REVIEWEDBY--------------------------------------------- ---------------------- ---- ----------- - ------------------------... DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------- ---------- ---- ------ DAT Alterations and/or recommendations:-.------------ _. C-__-� - ------------------------------------------------ FINAL INSPECTION BY:._._ ----- --- ----•----- ------- - Date-- ----- ---------- - ------------------------ 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.CO.