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= ,.-- ------� = '- __ - _____-�. APPLICATION FOR SANITATION PERMIT Permit No. .._-.1.. _.�� - ---------------- ------------------------------- 4W ----------------------------- = + . (Complete in Duplicate) ------- ------------------- This Per 't E 'res I Year From D e. issued Date Issued __ Application is hereby made f 'the a Jo oca eel istri a p r it to nsf A41�le work herein described. This application is made in cor�tp}t e-N �W JOB ADDRESS L TION.._=0 `3760 Su,,�y - f 6- ------�L ------ ---�-- Owner's Name------- _ ____��_-_--- t-- -- . ---------' -- ------------------- Phone Address________________ ---- - - --- - - �-- - -- - ------ ------ -• ----..... -------------------------------------------------------------------- Contractor's Name_______________ _____ - Phone---------------- ------- -• --------'-----•----------- •-------'- - Installation will serve: ResidenceApartment House Commercial Trailer Court E] Motel ❑ Other ❑ [I Number of living units: Number of bedrooms ___,lumber of baths _ Lot size ------Z- - -------------••-- Water Supply: PublicsystWr; ❑ Community system ❑ Private ❑ Depth to Water Table ____ 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 ❑" New Construction: Yes [❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permit+ed if public s9k.wer is available within 200 feet.) Septi ank: Distance from nearest well__--:-Distanc kom fourrdajioA------ �__..-.Ma,t,�" __ _------- -97 __ _______p No. of comportments_._-__:_ --_-. -Size -. -___Liquid dep•�th_-_ .5�—_____________Ca acit ._ P Y - Dispos Field: Distance from near ellDistance from foundation ___ / �x d !�-.______Distance to nearest lot ane___' ne_. , Number of linesr � '. fr yy , ngth.of each line_---- �- r------'.Width of trench.--- ---- -------- T e of filter. materiaL._a�- /r (� pth of filter material. ----------Total. length__--•__ ___ YP� _ - - .- Seepage Pit: Distance to nearest well__-__________________Distance from foundation------------........Distance to nearest lot line---Y______..__._ ❑ Number of pits -Lining material---------------•-------Size: Diameter------ ----------------.Depth----- ------------=------------- .0 Cesspool: Distance from nearest well_____________.-_Distance from foundation--------------------Lining material.__._.--------------- 7 ❑ Size:`Diameter-------------y`-------------------Depth------------- Liquid --------------Capacity y gals. --------•------•--- -•••- Privy: Distance from nearest well_.,_____________________ __ Distance from nearest building----------------------•---------__ ❑ Distance to nearest lot line__.._'- -_=_'------------------- --.---•--------------------- --•--------------- Remodeling and/or repairing,(describe):____-_---------- -------------- --------•---------------------------------•----------------•----------------•----------------------------- --------------------------------------------------- -- --------------------------------------------------••---------------------------------•----------------------------••------------ -=------------ ----------------------------------------------------- I hereby certify that 1-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)----------- 4:----- i ----'---------------------------------------- ----(Owner nd/or Contractor( = y ------ ----- -- ----------------------- (Title By:------ ------- - --- -- - ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on,reverse side}.:j ' w FOR DEPARTMENT USE ONLY- P APPLICATION ACCEPTED BY-.-- == ;'DATE - J"=------------------ REVIEWED BY_.'-•----------- ' ., _ .'.. -' BUILDING PERMIT ISSUED__----'____________________ -=--------------------•--- DATE__. ----------------------------------- ------- ------ Alterations and/or recommendations.-- -_ -- •------•---------- ----------------------- --------------- -----------j� - FINAL INSPECTION BY:--- -'- - ---- - Date__---- -- - SAN JOAQUIN LOCAL HEALTH,DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California loth,California Manteca,California Tracy,California ES•9 ACVI6EO H•59-I.P.0 fJ.'SM 6-6a •��