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FOR OFFICE USE; ------------------------,-.--..---.---.-------.--.---_-- APPLICATION FOR SANITATION PERMIT Permit No. -------- -------- ---------------- --- ---------- ----- (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. Thispa plication is-made in compliance with County Ordinance N 9. v .i . JOB ADDRESS A QCAT Nay � ---- - ------------ ------- ------- - �.--------- ---f- /!,/.r .... 71 Owner's Name6'Tly ------- 9 - Phone lV-_�� Addresst= r B ----- --------- -- .. ------------------------------------------------- - ��//� / Contractor's Name---------------------------------- �--- � ------------------------------- Phone.A_r&jWt/-r 7--- Installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1..---- Number of bedrooms ---!/_ Number of bathsLot size ..IP-P- _.... .Z —-------------------- Wafer Supply: Public system �1 Community-system ❑ Private ❑ Depth to,Water Table 70- ft. Character of soil to a depth of 3 feet: ;Sand [-] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe, ' Hardpan ❑ Previous Applicafion Made: (If yes,dae- ----------------) No 3�L. New Construction: Yes ❑ No S4_ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ase septic tankor cesspool public se� aallel 20 feet.) Septic Tank: Distance nearest well istanefomfounda 0ttF r -------- -.-.Material--------------------------------------- - ------- ❑<4i,5444 No. of compartments-------------- ----------Size----------------------------!__Liuidjjde th---------...----- -- Capacity Disposal Field: Distance from nearest we1l_A1Q-0E..�Distance from foundation. O--- ......Distance to nearest lot line__.'5__..-..-.. [ _ . . ) ',---Length:of'each"line-A.��f ry Width of trenchNumber of lines' G/. ! _....Total lengt .....e ..- $.t.. ...r./.._._.Type of fterpaterial . Depth of flter matrial _._._._._._.__._._._._._._-_. Seepage \ Pit: Distance to nearest well__/�.kJQ�_.---Distance rom undation_.-/..;....:___.Distance to nearest lot line..,-...._ Number of pits__0?<1. �. .Lining material--_,..Size: Diameter---- -!1....._Depth---.-.�.S-' Cesspool: Distance from nearest well-----------------Distance from foundation-------- ....Lining material---------.------------------------ -- ❑ Size: Diameter----- --------------- ----------------Depth---------___ter"---- ---Liquid Capacity-.-------------------------gals. Privy: Distance from nearest well--------------------------- --.. . ^.----:Distance_fro_M,nearest building------.------.-----------------_------___ ❑ Distance to nearest lot line----- -------------------------------- ----- ----------------------------I---------------------------------- ----- ----•---- - ------- -- -- or Remodeling and/or repairing (describe)-------- --------------------------- I t I hereby certify that I have p peed this application-and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules,/an regulations o the San Joaquin L al Health District. w c (Signed)---------------------- IOwner and/or Contractor) By:. Zr"""y" -- -------------------- (Title} ---------.._--------..----- .. (Plot plan, showing size of lot, location of system relation to wells, buildings, efc., can be plac4d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ - - -------- ----- ---------------------------------------------------- DATE---------`f j{/ " ------------------ REVIEWEDBY------------------------------------ -------------- - - --- ----------------------------------------------------------------- DATE---------------- - BUILDING PERMIT ISSUED---------------------- -- -------- --____-- _ DATE- .-- --- ------_________ Alterations and/or ret mendations .. �j..-_.. - �._----._.._ / / �- - X4.1 . ::: . . . _ ...---'-' -------- -------------------------------------' ------------------------..-.----------------------------------------------------------------------------------------------_-------_-----------------------.------------- FINAL INSPECTION BY------ ----- ........................------------------------- - Date.-------------------Y `-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Marlton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. '