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FOR OFFICE U-SE: 1 dam. . :APPLICATION FOR SANITATION PERMIT Permit No. 1701..... -------d-------------------------- -------f------------ r -- ----------------- --------------1--------1--- --- (Complete in Duplicate) Date Issued ---------------------- This Permit Expires 1 Ybar From Date Issued i A, I n •s r m o t e a a u^in Lo Ith Distr' o r s ct and install the work herein escribed. This i de ' omplun# ce�N 6 JOB ADDRESS AND WAI L ON-; � A Owner's Name-._ --------- ��_ —`'f -----------s..5_ _ _Jb P-- --- '----- ------------------- Phone = Address------------------Box ��l --------------------------------------------- ----------------- EII S`-- � =�� `----------- -•••---------------•----.-. --------------- Contractor's Name r ��-----' -t = , ----- Installation Phone ' Installation will serve: Residence_Apartment House ❑ Commercial 0.. Tirei er Court ❑ Motel ❑ Other ❑ •-� Number of living units: __J-- Number of bedrooms 3._'Number of baths_ __, Lot size _-.-..--26;_0��-._!��...�-_--_--- I Water Supply: Public system ❑ Community system ❑PrivateDepth to Water Table�.� ft. I Character of soil to a depth of 3 feet: SandGravel ❑ S .ndy Loam ❑r Clay Lam ❑ Clay ❑ Adobe l] Hardpan ❑ :.- . . _ _� r. _, 'Pre;;1 s Npplication Made:{lf y-es;date-__-__-_.._;� o New Confistrucfiori: Yes 'b�❑"`"'FHA%VTa:Yes =No ❑"` "� TYPE OF INSTALLATION AND SPECIFICATIONS: +' (No septic tank or cesspool permitted if-public sewer,is>available Within:200.feet.),...,.r... /C, Material Septic nk: Distance from nearest well__•-�___D.istance from foundation__ ___ �_ -_.__ __. MIf_�__F—:'T-M-------- NNo. _Li uid deth____ o. of compartments-----��-------------- Siz -F�� - --- - q p. �j� - .------Capacity-----1-,Z. - g� � ` � � ��._��Width�of trench:----�- Disposal Field: Distance from nearest a ._- 1 ._.Distance from ifoundation-_ _ _.Dis#ante to nearest of Number of lines`_ .__ _-_ Length-of each,line ��--------------- t = Type of filter mate ,al__._. �_ � Depth of filter material-_-� ..........__Total length---------- � ______________._ I Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_-.------_._---.- r ❑ Number of pits.}------------- ----Lining material----------------------.Size: Diameter-.- ------------Depth--------------------------------- . Cesspool:,l; Distanece from nearest well-----------------Distance from foundation______------------__Linin material----..._-_---------._-_-.------------. _ .. iy Size: Diameter--i=---- -------- Depth---=- =.- -Liquid;_Capacity------------------------ ance from gals. l � Distfneo es g I Privy: L .Distance,from.nearestewell------------ ------- , . building ❑ Distance to nearest lot line----- -------------------------------- ---------------------------------- ------------------------------------------------------------ Remodeling - -----Remodeling and/or repairing (describe):-------------------------------- ------------------------------------------------------------- -----------------------•-- ---------------------------- ----------------- --- ---------•------------------------------------------- t -- - L. I I hereby certify that I have prepared this application-and-that-t6 work will'be'done in accordance with San Joaquin County fl. ordinances, Sta ws, and rules acid egulations f th San Joaquin Local Health Ds+ric+. ,, yy; {0 •� F —(Signea) T �1 Y �- --- -------- ------ ---- --------------------------------------Pviner-�and/or-C-ontrac+or]� + 1 Iy:----------- - --• ---------- Tale (Plot plan, showing size of Itit,Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). t - ? F.tOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY i_ -----------------------------------------------------------------------tDATE------° .' REVIEWED6Y IDATE----- ------------------------ ----------------- --------- BUILDINGPERMIT ISSUED-------------------------- ------ ---------------------------------------------------------------- DATE------------- --------------------R----- ------- 1 Alterations and/or recommendations: t ------------------------- ------° ---------------•----------=------------ ------------------------------------------------------------ c ~ t l _.______.._____________________....____...____.______.._-_-x_.-....------t__-.---..-.._.___.------_____.__--________ _ - ---------------------------------------------------------------------- ------------------------ ----------------------------------------------------«---------------------------------------._._.------------------.------- ky 1 __ ____ _______________ ---------- ;_ .--.__.__.__._--.------------. _ ---- ------------------ S FINAL INSPECTI ' y - Date_------ ?- ------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod!,California Manteca,Californiaxacy California f