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APPLICATION FOR SANITATION PERMIT Permit No. ...2� . . (Complete in Duplicate) Date Issued ./�.'......�7 /y3- 03 Application is hereby made to the San Joaquin Local Health District for a permit to construct and ' stall +h work herein described. This application is made in compliance with County Ordinance No. 50. 7rs�Gf 4 Aja. v 2rtJOB ADe.v .ES ,4t6+ fA.TION... /�-�!-fP...�""....L.-./.. --- ---- --- ----- - �_ JOB ADDRESS AND L ....--...- . Owner's Name.----•-----.. .. .... -• . ..... ............. ............ - Phone.......-.................... Address----------- Q. ��ff - _..� - _...................... Contractor's Name..................... .IM'. .-............................-------...'.................... Phone/.Y.oCP..�.7 6/.--• Installation will some: Residencex Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofeell ❑ Other : - ❑ Number of living units -.-. Number of bed /... rooms02. Number of baths _ . Lot size _ lir�'�'`��!/—................. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Toblelsak-ft. Character of sail to a depth of 3 feet: Send ❑ Grovel ❑ $en y Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Mede: Yes Q No ) New Construction: Yes [INo B, 1FHA/VA: Yes ❑ No Ej--� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feat.) ` Distance from nearest well.................Distance from foundation..............._._Ma+erial........-.._.............._.................... No. of compartments......................_._Size.............—...........—Liquid depth.....__-.............--Capacity-................... � �i, gse Distance from nearest well.....____ _,Distance from foundation................—Distance to nearest lot line...........__. VI Number of lines_:................................Length of each line......................—.....Width of trench.................................. Ly Type of filter material._..._..................Depth of filter material.....__........_..Total length........................ ra a Seepage Pit: Distance to nearest all-._-7P.........Distan m}f��undation_.f�.-_...Disfan59 to nearest lot line......T' .... ............Lining material t. 3.6n �(p�....Size: Diameter_... ............Depth....a?,it._"..._....... [q;_� Number of pias...... Cesspool: Distance from nearest well.........__—Distance from foundation....................Lining material--...---- -.._-_ _.__. Q� ❑ Size: Diameter....................................-.De th._...................._.............. -----..Liquid Capacity--------- .r --•••--• a rrz Privy: Distance from nearest well.....____-__----.--�-----_--...—....._Distance from nearest building.— ......`-•a•--.... 9a "5e ❑ Distance to nearest lot line„--.-........�........_..,._........_....... —__._............ Rr�t- Remodeling and/or repairing (describe):......-....................-....................__..—__._._ _.. ._._ .........-------------------------------------------------------------_.--------•---•- 7----------.--------------—............-............................-...............—.....--...._...; 7 ......._.._......_...............----•--••----.--•------..-------------------------- •----------- .. ................ �-{ ...............____.................-........................................................................-........-._--------_-----------`-_.. ...................................... - I I hereby certh that I have prepared this application and that +he work will be done in accordance with Sen Joaquin County ordinances. Ste la s, and plirs and re tions of the San Joaquin Local Health District. q i (Signed)....... - �.. ...... nor and/or Contractor) Irk j - )1 BY: - - (Title).....E rd/f ------------------- ---------------- --................ iPlot plan, showing size of lot, locafion of Systd�fl In relation to wells, buildings, etc., can be placed on reverse side). — FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... ....... ................. . . . ... DATE.... . ------- -- - REVIEWED BY... - - - - - -............ - .................. DATE----- - - ........__.-_ BUILDINGPERMIT ISSUED.......--.........-....................................-.................................. DATE...................-------......--..... ....._....._ Alterations and/or recommendations:.._._......___.............. ................._-_._.--•--.----•---------_—................___._...._.._........ __.._.._.-. _..................................._..................-------•----....------...-------- ---._.-. ---- ----•••-------•------------------ --.............._........_............---•-------•---•--.__._............I..---..r.. --...._......._......._...--------- -----•---._..._------••----•------_._...----•-•------------...........-................-..... .......__................. .... -- --..._•--.-..__._.............----------------..---------. .._...._............_._...-'-------------........_......---------...._.. _._. FINAL INSPECTIONno-W, -. - ..-.:_... Date----2 SAN JOAQUIN LOCAL HEALTH DISTRICT �I � 1 130 Soufh American Sheer 300 Wert Oak Street 132 Sycamore Sfreaf`� 814 North '•C•' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , R.,4.a 1.57 F.P.CO.