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urrILt`u5t r f 3a 6 - r _ - ) APPLICATION FOR SANITATION PERMIT Permit No. ........................� (Complete in Duplicate) / - This Permit Expires 1-Year From Date Issued Date Issued ___9f l_]. �¢--�__ 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. 514-9, JOB ADDRESS AND LOCATION ---- IS,�__ /� Q�' Owner's Name-------`✓d�, -sl-+S _ri .--•-------------------- -- Phone------------------------------------ ----------- --------------------------------------- -- Address----------------•----- ---P 1 4-a---------------------------------------- - ------ yl- =Contractor's Name.- _/� ------------ ------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y Number of living units: _ __- Number of bedrooms &-- Number of baths ________ Lot size -_ r1'imunity system E] Private E] Depth to Water Table ft. Water Supply: Public system � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe ©r'IHarcipan ❑ Previous Application Made: (If yes,date_--------------- -) No New Construction: Yes Vo ElFHA/VA: Yes ❑ No R •-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well--------- Distance from foundation----/A--------Ma_teriai___ [ No. of compartments..... - ----------Size_..a_.9j60_____________Liquid i --------,Capacity �--- �6N�..-- _.____.__. Disposal eld: Distance from nearest well------ ''___._Distance from foundation_``�_l7__F______-Distance to nearest lot line__�S__----_____ q Number of fines___ __ _________________Length of eachline_ _,J--_,` S'__- Width of trench__c;_�-Y.. ......-_____-------- V I Type of filter maferial_,/3V'j6ek'�Depth of filter material--- U Total length------------------------------------------ Seepag it: Distance to nearest wall_-_�' ---------Distance fr fo dation--- d ___.Distance to nearest lot Number of pits. ---____._Lining material__ i l.Size:-Diameter �, ' 1 G .� beptn_.r.Z 1-_7--- Cesspool: Distance from nearest well-------------__Distance from foundation--------------------Lining material----._--________.__.________--_____. ❑ Size: Diameter----------------- --- ----------------De th------- ----------------------------------- --.Liquid Capacity-------------------- t---gals. Privy: Distance from nearest wO-----------___---------------------.----------_-_Distance from nearest building------------------------------------------ _ .❑0 Distance to nearest lot line... Remoeling and/or repairing (describe):---- -i.!✓_____�_y ,r' �-,q ....... p_�Qj t-(�------ _ —.�,�-------------- �- ----- / -----------------------------------------------------------------------------------------•--------------••---------------------------- -------------------•-------------------------.------------------------------------- ----------------------------- - -------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ ------- / 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, an tl�essaand regulations of the San Joaquin Local Health District. { (Signed) a - {Owner and/or Contractor) By:---------------------- d� , ,��- ------{Title ---- ------- (Plot plan, showing sof lot, location of system in relation to wells, buildings, etc., can be placed on reverse` FOR DEPARTMENT USE ONLY M. APPLICATIONACCEPTED BY--------------------------- - -' -- ----- --- ------------- - -------------------._---- DATE----------------REVIEWED BY------------------------- ------_._---------------- ----------- --------------------------------------------------------- DATE-------------- ---- - �-- --- - ,�-- ------- i ---` ! ------- ------------------ ------ BUILDING PERMIT ISSUED--------------------------------------------------------------- -------------------------------------- DATE Alterations and/or recommendation -_-- _ 411',_ ---------- ----- 11------ --------- ---- -----------------•-.------------------------------:------------=--------- - --------------------------------------------------------------• _-------------------------------- _. "' _--q (---5-- FINAL INSPECTION BY:___! .__ - �C'�'� - — Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Stree Stockton,California Lodi,California Manteca,California Tracy,California