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FOR OFFICE USE: --------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__./_. a� _y.. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework herein described. This application is made in compliance with County Ordinance No. 5499.6 JOB ADDRESS AND LOCATION----,3-3-3-0----- ©off ----- ••---- --=- - ---------------- Owner's Name -•_ c-n/yJ�:_ 1: ----------------------- Phone-- �1` - "15. ' Address -- ------------------------------------------------------------------------------------- Contractor's Name----- - ----------------•--------------=--------- Phone.--------------------------------- # ------°L�------- --------------- Installation will serve: Residence ["Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-I_-- Number of bedrooms _J--- Number of baths .._ Lot size -----F-2_14V ---131 O Water Supply: Public system C Community system ❑ Private ❑ Depth to Water Table -J'—Vft, Character of soil to a depth of 3 feet: ISand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---...---------.....) No [T"' New Construction: Yes [!I'No ❑ FHA/VA: Yes ❑ No n' + 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 �founclation_.��-.-__-____.Material. No. of compartments-----,�.............----Size---4.'R4";,�__ _._-_.:-__Liquid depth__.--— -----___---_.-Capacity_., D__o.�-• I , Disposal Field: Distance from nearest well...-.---__-_Distance from foundation-_-.1-0_1--------- to nearest lot Number of lines-__�=�--------------------------Length of each line----90-__`_----------------Width of french,...�--5�-p•----------------- Type of filter material_3-0-C ------_-Depth of filter material-.��.4.._________.Total length__/8'0_`___________________________ � Seepage Pit: Distance to nearest Weil_ .__.___..----------Distance from foundation/0----------------Distance to nearest lot line-011_______ W [1-- Number of pits.-.?.�:_-----__-_Lining material:�Q.G_4---__-Size: Diameter---35 -....--..___.Depth__.�sS`__'_-- 0 Cesspool: Distance from net ' s p rarest well_________________Distance from foundation___.__.____.____..Lining material__._.__._.-_._.________.___________. ❑ Size: Diameter----- ------- -----------------Depth----------- --- -------- ---------------Liquid Capacity- -------------------------gals. N Privy: Distance from nearest we]L------------------------r_.__-____.____------'_Distance from nearest building--------------__.---_______---.--.---_.-. ❑ Distance to `nearest lot line------ ------------------------------------------------------- ------ - ' 1� iG Remodeling and/or repairing (describe)-------- ----------------------------------------------I----------------------------------------------------- -------------------------------------- III- --------- - - -I i ------------- ---------------------- ( } I - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 and *regulations othe aqu' Local Health District. (Signed) '' ------ - -------- --------------------- ------------------------------------------------------------(Owner and/or Contractor) g )---------------- BY:----------- ----------- - -- ---------- -- --- -------------------------- ---------------------- - - -- --- --)Title)--------- ----------- ---- ---------------------- (Plot ...-- - -- - ---- --(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). .f FOR DEPARTMENT USE ONLY 6_ APPLICATION ACCEPTED BY ------------------------------------------------------- DATE_ /_f-- REVIEWEDBY-----------------------------------------I---- ----- --- -------------------------------------------------------------------- DATE-------- ---------- BUILDING PERMIT ISSUED-------------- -------------------------------------------------------------- - ----------------- DATE- Alterations and/or recommendations:_� - 1/= `�o � 1- = i . -----•--- ---------------- -- -------------------------------------------------------•------ -----------=----------------------------•----------------------------------------------- ---------- --------------------------------------------------------------------------------- a - ----------------------- ------------------------------- ---- ---------------------------------------------------------------------------------------- -- FINAL INSPECTION BY: I -------------- Date -/,�------1�`� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o.