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..-� FOR OFFICE USI=; r. : ------------------------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. . .. (complete in "Duplicate) Date Issued ___ c- --- -- ----- ......_ ;3 This Permit Expires 1 Year From Date Issued is hereby made to the San Joaquin Local HealthDistrict 5f4r a permit to construct and install the work herein described. Application Y This application is made in compliance;with County Ordinance -� c`, JOB ADDRESS AND LOCATION... phone--.--------------------•-------•--- Owner's Name------------------------ d ----------------- Address -------------- ------------------------------------------------------ R �i Address-------------------•------ -- ------ Phone�.36741�1� 1.. (,�_�� Other ❑ Contractor's Name___.'______________DOA Commercial ❑ Trailer Court ❑ installation will serve: Residence �Ap c� artment House ❑ --_. Number of bedrooms _wC__ Number of baths ...t__ Lot size _a_�_____ __ Number of living units: __ =t th to Water Table P-D ft. Private p�Dep Water Supply: Public system ❑ Community system ❑ --- Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Qf Y No 2'FHA/VA: Yes ❑ No Ch 1 No [ New Construction. Yes ❑ Previous Application Made- (if yes'dote--------------- - 116ue 1,4J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seer is available within 200 feet. r1r i nearest wel4__I� - Distance from foundation--.1-D---------.M`at :`al------ e C _ Distance from T Septic Tank: Q+� ��` � Li u+d depth_-- --�-�.-`- --------Capacity___f L 0---- maize--I No. of compartrnen#s....__. ---- ----_.Distance to nearest Iotrline_ .._ --- ----- ' Length of each line_____.__- ------------Width of trench_._.__ ------- i, Disposa4 Field: Distance from nearest well.__f� ----Distance from fours a +on_.-- �� [� Number of lines g Total length_._ Type of filter material_ _ ,_. Depth of filter matenal_._1 ------- f Distance to nearest well_________.___.____--Distance from foundation Depth to nearest lot ine_-"----------- -- Seepage Pit: Size: Diameter.------- ------- Depth -------------------- Seepage --- -------- - ❑ Number of pits----------------------Lining material.------------ ` Cess ool: Distance from Lining material----- -------------------------------t nearest well---------------=-pet+hce from foundation_.-= Liquid Capacity_.: _---- ;� g ` p ❑ Size: Diameter _-- - - Distance from nearest building._ --- - ----- - - -- �� -- - --------------- -- -- - - - - - ��-�•-�"" Distance from nearest wel.___ -.-- ---- -- --------- -- Privy: ,? --------------------------- --------------------------------------------- ❑ Distance to nearest lot line----------------------------------- ----------------------------------------------------------•-------------------- -- Remodeling and/or repairing (desc-- a):--__-_-___------ -- - ---------- ------ - --- - ------------ I ----------- - i ---------------- I hereby certify-*at I have prepared this application and that the work will be done in accordance with San Joaquin County = ordinances, State law ', and les and r ulations of the San Joaquin Local Health District. Owner and/or Contractor) (Signed}. _:-sem (Title)------------------------------ - - ..._. -- - -- ---- ------ ------------------------------------------------------ -- BY:---------- -------------•--•--•-------i. plot tan, showing size of lot, locatio of system in relation to wells, buildingsr etc., can be plated on reverse si e. t r t'f FOR DEPARTMENT USE ONLY k / 1_____________________\ -- DATE----- �-----�G--Z-�- ��- \\ APPLICATION ACCEP ------------ ----------------- -- --------------------- DATE----------------------------------------------------- REVIEWED BY----------------- ---- - - — --------------- Pr --- --- - DAT BUILDING PERMIT ISS -- - _ ---- ------------------------- --------------- Alterations and/or recommendations:_-____---------- - - -- -------- ------- __._____..._.___.- -------------- ------------------ - -------------------------------------- ----- ---- --------------- ate---- -- ---- 2; -- -- ----- - -- ----- FINAL INSPECTION BY:------ ------ ---- ----- -- - -------- - SAN JOAQUIN LOCAL ALTH D RICT sycamore Street 205 West 9th Street 300 West Oak Street Tracy,California 1601 E.Ha:elton Ave. Manteca,California I Locii,California Stockton,California F.P"C O. a