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FOR OFFICE USE: •a-• �i APPLICATION FOR`SANITATION PERMIT Permit No. ._.l� --•-5_-• ------------------------------ --------- ---- - ( lete in Duplicate) p.u licaite) ` - __..__._.._P ________.._- ............... This Permit Expires 1 Year Frompermit Issued Date Issued �Q_'��_�-� Application is herebymade to the San Joaquin Local Healfh District fora to construct and install the work herein described. This application is made in compliance with County Ordinance NOA / •T"�,, , �`--------- '/y`- JOS ADDRESS AND LOCATIO : { � J----_------- - --- -• ------------------ Owner's Name / U l��---------------- -------------- •---------- ------------------- Phone � --- ----- - ---------------------- Address------7t -------------------•-Address-----!1L ',-e-t- ........................... f/► ------------------------- Contractor's Name---- - 4 - t - ---- -- -----•---------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Z �07 Number of living units: ____'.1_ Number of bedrooms ---- Number of baths _1.._ Lot size _rii`7f1J _ _ �- ------ Water Supply: Public system ❑ Community system ❑ Private [2[ Depth to Water Table.:O_Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Z Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----------------._..) No [X New Construction: Yes Na ❑ FHA/VA: Yes ❑ No o TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool; permitted if public sewer is available within 200 feet.) Septic Tank! Distance from nearest weIL.,90'-----Distance from foundation___ LMaterial____. aitments_____ p rm.---------------Size. _.X- X Liquid depth - ` ' Capacity U No. of com !y Disposal Field: Distance from nearest well._la C.._____Distance from foundation________f___ Distance to nearest lot line Number of lines----------='"'S_--------` •......-..__Length of each line---------- 1_-.�..____.W,idth.of french----�-----�----------------- .� Type of filter'material____._ 4,4-Depth of filter material------- ____...___Total length_______f __Q_.________________.._ 7_ >ee Pit: Distance to nearest well__.____,.______- Distance from foundation-----._-__._______.Distance to nearest lot line-_.------------- p Number of pits----------------------Lining material-----------------------Size: Diameter----------------- -----Depth---------.-.--------------------- o Distance from nearest well-----------------Distance from foundation___ ---- ------ _.Lining material---- __.______ i Size: Diameter------------------ --- ----------_Depth-------------------------------- --------------------Liquid Capacity----------------------------gals. i Pri Distance from nearest well-_------- ------_ -----------------------------Distance from nearest building------------------------------------------ stance to nearest lot line-------------------------------------- ------- ------------------------------------------------------------------------- ------------------ - jcribe):------------------------------------- - --------------------:------------------------------------- ------------------------------- Remodeling and/or repairing d � -----------•---••-•----•-----•--------------------------------------------•----------------------------------•------------------------------------------------------- -r--------- w --------------------------------------------------------- -----------------•-•-------------------------------•-------------------------------------------- ------------------------------ --- .I ---------- ---------------------- ------------------------------------------------------'----------------------------------- ---------------------------- ------------------------------------------------------------------- --------------- - -- ------- - I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed_ -- ------- ---------------------------- -------- - -�6wrrer-<wd/or Contractor) - --------------- --------------- 1 c BYr? - --------------------------------(Title)-.-------- - ------------- ------ - -------- (Plot plan, showin size f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Wr. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --'--�,...r. . J�.-------------------- ------------------------------- --- DATE-- l ------------------------ ' DADATE REVIEWED BY------- --� 1 ------ ------------------ TE --- BUILDING PERMIT ISSUED ----- =`---------•----------- Alterations and/or recommendations-------- -- ---------------------------- -------------------------------------------------------------------------------------•------------------------------- :I ti •--- -------- -------- ---------- - --------------- -- - --- ---- ------ z ` --------- --------- --------- ----------- - 1 ----------------- ---- ------ O - . ----- FINAL INSPECTION BY:.[� 4 �I ` Date.... a. _.v8------- 6---1---- ------ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hazetlon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.