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FOR OFFICE USE: ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .-�� --------------•--- - ------------------------- --------- (Complete-in Duplicate) -7 This Permit Expires 1 Year From Date Issued Date Issued .__Dr/7� . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her 'n de cJilz-ed. This application is made in compliance with County Or inane N 5 �'�9ST •S! DE' �.51��7�NC" AL0 mss 0,v JOB ADDRESS AND LOC/ATIONN- - --- -- ---- ---- -- ------ --``-- -------- - - --------- -------aN�h" t'f Q-_.Ifl_�fi4�tl 7._AVA Owner's Name � �"� - " - L p Pho -- Address--------------------------- .moi aX...- _L __-_� ---------- Contractor's Name----- # ---•--. 1q_ R__t.S_.{... Q f-=S-----------. Phone 4 t Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __._ Number of bedrooms ___-- Number of baths_Z._ Lot size --�__�'�- ----------------------------- Water Supply: Public system ❑ Community system ❑ Private), Depth to Water Table 7-5-ft (� Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe ❑ Hardpan ❑ `$ Previous Application Made: (If yes,dote_- ---------- ) No X New Construction: Yes X No ❑ FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3. _. 0 Septic Tank: Distance from nearest well_....._..-----Distance from foundation_.__- Material .... I .- --- -------- No. of compartments---- _______________Size_A.K-VX.4 -_Liquid de th__-57-.f! __Capacity/ZO�CrAL SP t ------------Distance to nearest lot line----------------- Disposal Field: Distance from near t __ e€I _•--��_�._._._Distance from foundation_. __ _ { Number of lines.__L _ --------/1 Length of each line__Are-- . t.f_..._.Width of trench_ ..---- _______________ Type of filter material__..i __-_-Depth of filter material----- ----------Total length_._._: _._____._ ------------ Seepage Pit: Distance to nearest wel __ tQ�_..____Distance o_m f�;undation_IkQ_`_..Distance to nearest lot line_j2:s-f__ Number of pits---L ___--Lining material__ 6--- _. Size: Diameter--- -3.----.. Depth---, ------ Cesspool: Distance from nearest well ----------------Distance from foundation____............ ..Lining material_._.____.-_.________.____._._..______- ❑ Size: Diameter- -------- Depth--------------------------- ------------ Liquid Capacity----------------------------gals. Privy: "' Distance from nearest well-------------------------------------- _________Distance from nearest building-------___.__..______________..._.._-..._. ❑ Distance to nearest lot line ------ ------ --------------------------------------------------- ------------------------------------- --------- --------- - Remodeling and/or repairing (describe) ------------------ . -------- - --- ---_. �• -- -- ----- ------------------------------- 0-- ------------------------------------------------ z �- --------- -------- --- --- - ---------- L44---lit -'---------•------------------------ -- ----- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru s and reg tions of;+he Sa Joaquin Local Health District. i ---------------------- - -: .---._Owne and or Contractor (Signed)---------------- ---- -- -- - -----------�-------- ------ � ------------- ( �or ) 13y:.-._ -- C1 (Title) ��[-�----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY; .. -� -------------------------------------- -------------- DATE. b-- /-J--7-4-/7------- -- -------------- REVIEWEDBY-----------------------------------------__ --- --- - - -----------------------------------------------------------------._ DATE---------------- ---------------- • •- •------------- - BUILDINGPERMIT ISSUED-------- -- --------------------- ------- - -- - --- -------- ------------------------------------- DATE------------------------------- ---------------------------- Alterations and/or recommendations:--------------------------------------------------- ------------------------------------------ --------- ------------- ------------ ------------------•---- ----------------------------- ------------------------------------------------------------------------- ---------------------------------- --------------------------------------------- ----------------------------------•---•---------------------------------- ........ -------------- --------------------------------------------------------------------------•----- ------------------------------------------- FINAL INSPECTION .. � 4. Date- � � �~G 7 -- ---------------------------------------------------------- SAN . . 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 E.H.9 2M 1-67 Vanguard Press