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_1y. ul•-(vN _ .�.�-3" d '............ __ ._... APPLICATION FOR, SANITATION PERMIT Permit No. (Complete in Duplicate) _._ This Permit Expires 1 Year From Date Issued Dote Issued ��'lc .-�� Application is hereby made to the San Joaquin Local Health District for a permi+ to construct and install the work herein 4esc.ribed� This application is made in compliance with County Ordinance No. 4 , /pso ,"k/, r JOB ADDRESS AND LOCATION ./__4 `�Gr L7 /�-.�_..�jG -�'I Q/4/�(� .._ '. %/ = Owner's Name_.....�2 /--- �- �. Phone------------------------------------ 4/7 Address t - ...... �/ft'��//r-� - ,l�t'�� ----- ---•-- ----- --- --------- --------_----------- -------..--.- Contractor's Name.. ._.... .. _. _ Phone-------- ------------•------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®--' Number of living units: ._--- Number of bedrooms Number of baths ... .. Lot size -'_............._..__..____. . _.. i Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _vfp 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 Z�/' New Construction: Yes gR-No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: C (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Septic Tank: Distance from nearest well l„��. ..Distance. from foundation.Ze--- Mate ia -aw/.... ... __.-. t/ �,,? r� No. of compartments-j- . .. _ Sizel..X/Q...,?,��.-Wiqurd depth__-�/f _...... Capauty ...Ap _..-- Disposal Field: Distance from nearest well1,lQn Distance from foundationf.7, ._. Distance to nearest lot line-.%O.�....�... ®/ Number of lines _ , ._� ._. Length of each line 25'e .fC- .6" �/Vidth of trench.;Z... ..__._.... ._. ff�� r Type of filter mate ria / ^f.__ Depth of filter material. S7 Total length ............... Seepage Pit: Distance to nearest well _11.Q Distance from fo rication-49621. Pistapce to nearest lot �ne..4--. Number of pits . !. _ . Lining material...16V! . Size: DiametetZo 'e Depth _ ..................... Cesspool: Distance from nearest well Distance from foundation Lining material. ___... d ❑ Size: Diameter Depth. Liquid Capacity. ... . .._...gals. 1 Privy: Distance from nearest well _ . _ _ Distance from nearest building- _ _ - - ..._...__. ❑ Distance to nearest lot line __ _ __ __ - �_.,/- ----.---_.. i Remodelin and/or repairing (describe): T �. -a�!��X�' - - --- - ,- ....... _. - - -- ----- _ - ----....-------- -- - ----- ... --------------- _. - .. . .... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation of the San Joaquin Local Health District. (Signed)---------- -- - --------- _ .. JCLwn&e=&mdyor Contractor) By:------- -------------------------- -- --- --------- --- .. -- -G�'�- ....-(Title)-.E (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ___...._ _ --- ------ ---------------------.-.--- --- ------ DATE. � REVIEWED BY............. .......... - __ ---. . . . .. - .... DATE _ _. ..._... BUILDING PERMIT ISSUED...... . . . .... .. ....... _.------------------------------------- ....... ........--------- DATE.. ... ----------- --- ------- -------- Alterations and/or recommendations:..... _.. .. .. . _. . -- -------------------- ----- ------ ---- --------- - ---------_---------- .. -�,• L. ..�'`'s^'�... . ...._ .... ..._ ...... -- -- . ---- FINAL INSPECTION BY:. .._.... ............ .... . Date-- -- .........bb. ---- ...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.