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FOR OFFICE USE- --------- ------------------- ------------- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. "-?../ [Complete in Duplicate) f 7 -------- ------------- ------------- --------- Date Issued �'!._ --- ----------------------------- - --------:_._ This Permit Expires 1 Year From Date Issued �' c!3-3oa�t-1D i� P+pplicati 1 is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. Y r This application is matte in compliance Lwith Cou ty Orda"ncl No.�J^5 K— I � �iN (f�J r!�Q�eN Cf} C0 Nomfgor r-7 GrJOB ADDRESS AND LOCATION 't_ Wjxao, IEj .. -- - Phone:= — _ - - -------------- ...AdressI ------------------------------------------------------------------------------- � 3 ; Contractor's Name__. .. s ------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ frailer-Cour lvlo eel ❑ Other Number of living units: -_l_._ Number of bedrooms -------- Number of baths -------- Lot size------ 7_ --- - `'---------- Water Supply: Public system ❑ Community system ElPrivate X Depth to Water Table-__-_____ft. `y .. ' Character of soil to a depth of 3 feet: Sand ❑ ravel Ll Sandy Loam Clay Loam Clay ❑moi d`ob ❑ Hardpan E] Previous Application Made: (If yes,date------ 1 No ❑ .New.Construction: Yesg No ❑ FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION { P p P trot well____� __ D stance from found tion__-__/o__" C jG� No septic tank or 'cesspool ermifted if public sew r is available within 200 feet.) �,, Septic Tank: Distance..:from nea es � Ma#eraai_ __ f? '---------- No. of compartments_________ _____-- � _ _.___Liquid dept - Capacity:-____ �---- __ Size_----3X__9� - - - € Disposal Field: Distance from-nearest well.--�`Distanc-e-from:fauradat•ion_—`d____ -Distance to nearest lot _ Length of each line----------- Type ___________ /�_ Width of trench27-__.__ T Number of filter material 5; -- C_ -c14De th of filter ma4erial___-/5 -�---'_" --�1------� -- I -- ---Total length -- Seepage Pit: DistanceJo nearest well----------------------Distance from foundation-------------------_Distance to nearest lot line__-__._._.____._ ❑ Number of pits--------------------- Lining material_--__ Size: Qiameter._.-_______+-_-_._.___De th___f---------------- ------ . Cesspool: Distance from nearest well_________________Distance from foundation--------------.__.__.Lining material_._.-_ '__-_____-.___.________._-___. J ❑ Size: Diameter------------------ -------------------Depth.--------- ---------- ------- -------------------- Liquid Capacity-----------------------------gals. G! Privy: Distance from nearest well______________________________-___..--.____._.-_Distance from nearest building-__._.-__ _-1. -_ [] Distance to nearest lot line------ - --------------- -----•------------------------------------------------- -- - r A- /____ ef/L ! ___• _ ---------- Remodeling and/or repairing (describe):_-. _ T__- -------------------------------------------------------.---------------------------- __----__-________________.__- _________________________________________________________________________•-_________--____----___-__.-._ _______-__�_,___*_____________ -----_____ _______________________________________________-_____________________________________-__________________-_____________________________________________-__-_________-_________..---____ -.____-------.___-._..____ I Ilhereby certify that 1 have prepared this application and that the work will be done in accordance with San Joa County ordinances, tate laws. andirules and regulations of the San Joaquin Local Health District. I (Signd)_ P� C�f--':� SCJ- ---- _ Owner and or Contractor -� -' --- --- ( ) r ------------------------- Title --- -------- ------ ---------- --- ....---'--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY —1A-- - DATE _"1�_1 _7---------------------- REVIEWED BY ---------- - --------- -------- DATE - BUILDINGPERMIT ISSUED------------- ------------------------------------------------------------------------ DATE Alterations and/or recommendations--------------------- -- --•--------------------•-----------------------------•--•----••------------------------------------------------ -------_------------- ------ -------------- -------------------------- ----- ----------- ----------------- ---------- -------------- --- ---------- - ------ ----------------••----------------------- FINAL INSPECTION BY ..-:-------'--- ------------------- - ---- ----- --------- Date_.-. - --------- -- ------------------•--------- 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 I Tracy,California