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FOR OFFICE USE: -----:------------ - ----- ------------- ----------------:---------------- -------------_.____._-_-__:---------------- ------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. ..f_-/-- �� -------------------------- ` ------ (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 the work herein described. This application is' cl in comp' wgth,County Vna No. S49. � � s �JOB AbDR SS ANLOCATI N______� �'? --- JiR /YOwner's Name--------------- nAe /lq C --------------- �� -------- ----------------------------- -----.-. Phone---- Address-----------------•-------- -r'pr_.-t9t---_ Contractor's Name Com/��f �11�_----�"` Phone__ a.�----- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms __ `' Number of baths __L____ Lot size __ r{ f3 - '-------------------------- Water ___ ____________________Water Supply: Public system ❑ Community system ❑ Private Z Depth to Water Table _k? 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 D-' New Construction: Yes ❑ No a FHA/VA: Yes ❑ No [9� TYPE OF INSTALLATION AND SPECIFICATIONS: No se fic tank or cess ool permitted if pu6lic sewer,is available within 200 feet. _ `�' .5 Septic T k: Distance from nearest well_-� __ __Distance from foundation_;9'9___-_____.Material_______.l�________-____ _________________ / Sep; No. of compartments------------ �'_�__X__----__Liquid depth____-�Y__`-/_.-.-...Capacity__2 _ / Disposal field: Distance from neare well_._�_�-Q__----_Distance from foundation___.. to nearest lot line__/pe>__f_ t Number of Ii. ________Length of each line' 1 _ < ._.Width of trench------ ?f��_f.__-.___ --------- Type of filter material- '.,tr"/ ' .--Depth of filter material-_IcC"_--.----Total length-__-_lAa--- ---------------- \ Seepage. Pit: Distance to nearest weft___/�70__/--------Distance fr m foundation_73__---------Distance to nearest lot line___fr'�__�.� W _ _ Number of pits____-___--------Lining mat erial__Z'//'8K�-Size: Diameter..�;_.............Depth__:_;F,_f______________ Cesspool: Distance from nearest well-----------------Distance from foundafiion--------------------Lining material---------------.___-__-_________-__- V ❑ Size: Diameter------------------------------------Depth----------------------------------------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---__-.___-_-_-_____-___________-_-__---_. ❑ Distance to nearest lot line---------------------------------- --------------------------------------------------------------------- ------------------------------------ �. Remodeling and/or repairing (describe):------ 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 and regulations of the San Joaquin Local Health District. a t-1_' n St ed --------------------- ----� ---------1--��--- - ----------�-- - ----�� ----------------------------------------------------- ---------- ------------------------ ----------- win ;;and/or Contractor ` _... - -��B .-=---_�---T-•----- -------r -=------- R - ..�--------==----= =----=------------------------------ =Title - �.--_ ---_-- - .-----.-- --------- (Plot plan, showing size of fat, locatio of system in relation to wells, buildings, etc., can be Placed on revers side). i FOR DEPARTMENT USE ONLY APPLICATION AC ED BY -- l�� -------------------------------------------------------- --------------------------- -- - — REVIEWED BY� ---- --- -- - ------- DATE-A], 4 -~-- --- ------------------ BUILDING PERMIT ISSUED----------------------------------------------------- ----------------------------- ---------------- DATE------------------------------------------------------------ Alterations --- ------Alterations and/or recommendations:------- ----------- --------------------------`-----------------------------------------------•-----------•------------------------- ---------------------------------- ---------------------------------- ------ ----------------------------------------------------------------------------------------------------------------------• ------------------- -----------------------------------------------------------------------------------------•--------------------------------------------------------- ------------------------------------------------------------------------- ------- - -- --------- - ---- - -------- - - --- ------ -------- - ------- - ------- ------------------------- ----------------------------------------------------------------------- ----- //_3 ��` FINAL INSPECTION BYA41 - -------------------- Date -------------- --------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Loch,California Manteca,California Tracy,California