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FOR OFFICE. USE: ------------------ ----- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ------------------------ (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 made in complianFifhunfy O finance No. 9. JOB AQDRESS AND LOCATION •-•--•-•-------------------Owner's Na -•---------------------------------- - Phone'.?_. Address.-- -•---- -•- - ---------- --------------•--------------•--••----`----------------•-. / Contractors Name �G h Iver-------- 3` Installation will serve: Residence E!� Apartment House Commercial ❑ Trai er Court ❑ Motel n Other ❑ + 7110 Number of living units: __ mber of bedrooms _ ..__-_ Number of baths !_____ Lot size _//sal--_- -- -- -- -------------------- Water Supplyt Public system Community system ❑ Private ❑ Depth to Water Table 60ft. 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 E] New Construction: Yes [:] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se c�ic ' n Distance from nearest well-----------------Distance from foundation__________.____-_Material_________________________________________________ fNo. of compartments---------- --------- ----------•------:Liquid depth--------- -------- Capacity-_Size______________ -_Ca acit . field: Distance from nearest well_________________Distance from foundation-__.__-_______.__Distance to nearest lot line_______._________ Number of lines---- --------------__.__._.__.__Length of each line____:____._______.___---:-_Width of trench___._________.______-___________-__ Type of filter material_________________________Depth of filter material-----------------------Total length__________________________________* Seepa e Pit: : Distance to nearest'well�O�-----Distan rom foundation--- - ---------Distance to nearest lot line__. 90 f` Number of pits___�_y`____-__t_,Lining material- Size: Diameter__,j�-��____Depth_.,Z,r �.____-_ r Cesspool• Distance from nearest well-----------------Distance fro foundation_____--___-_______..Lining material__-_____________-___________________. ❑ Size: Diameter.----.--------- ---------.Depth------- --------------------------------------------Liquid Capacity-.--------------------- -gals. Privy: Distance from nearest well----------------------------------------.---------Distance from nearest building-_-__-..-----_-______.________..___.__._. ❑ Distance to nearest lot line-._-;�------------- ---------------------------------------•-----------------------------------------------------------------------------r � Remodeling and/or repairing (describe)-------- ----- -- --- /- - --------- --- t - -----------------••-------------------•------------------------------------ G,Gs _®/.?ZJ` Bd��l -�llte /_1? ------- I hereby certify that aye prepared this application and 'that the work will be done in accordance with San Joaquin County ordinances, State laws, mules and regulations of the San Joaquin Local Health District. (Signed)--------s�PrlC__'ri N-K--j5�E-------------- �'or Contractor) ----------------------- ------- ------- -------------------------------- 29].5 E-.Miner Ave., HO.6•3343-------------------------------------- ------Title ------------------ ` [Piot•plan, showing size of lot, location of system in relation to ells, buildings, a ., can be placed on reverse side). —� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- /t�--------------------------------------------------- - DATE- --- S� REVIEWED BY----------------------------------------- -- ---- ---------------------------- ---------------------------------------------- DATE------ ------ ----- ---------- ----------------- BUILDING PERMIT ISSUED------------ --------�-7-�-,-�--,--------------�--- - DAT L Alterations and/or r c m ndations ---,l;D ;5 - ---� a --- t 1 �:------ � 5`"-------------- /I ----------------- ---------------------------------------------------- -------------------------------------------- =- �--- --- - a _/--------- -------------y 1 ` ----- .0 - F&;-------------- ----------------------- ------------------------------------------------------------------------- __ . <<rI ------------------------------------------------- FINAL INSPECTION BY:------. - - --------- --------------------- Date-- --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 16014.Hc&elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CLL