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FOR _G_OFFICE USE: - --- - - ------ APPLICATION FOR SANITATION PERMIT .-a ._ 3 !�---- W/- l (Complete in Duplicate) ---------------------- This Permit Expires 1 Year From Date Issued Date Issued /_Q__1.7__G� Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4[the work herein described.' This application is made in compliance with County Ordinance No,5O. JOB ADDRESS AND LOCATION----- .Z.--�' ------- -- ---- - -------------------------------------- ------------- Owner's Name---------- .-----AGWV;17je:--�--------------------------------- ------ Phone-------------------- Address-------------- �� / -+ -------------------------------------- Contractor's Name---------------------- �Ze_p- = t-� ------------- --------------------••----------------------- Phone----------------------------------- Installation will serve: Residence [?"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __/-_ Number of bedrooms '_ Number of baths Lot size Water Supply: Public system Z__1`C*ommunity system ❑ Private ❑ Depth to Water Table ______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [d-{ardpan ❑ v Previous Application Made: (If yes,date--..___.--_-_____-) No ®— 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 tic T k: , Distance from nearest well_________________Distance from foundation-------------------Material.......------------------------------- _.__.____. riv vflql No. of compartments--------------------------Size--------------------------------Liquid depth-------------- ---.Capacity Disposal Field: Distance from nearest well____-'�...._Distance from foundation___.�.`�__-/.__.Distance to nearest lot line_-_&--�_____ 5 � Number of lines-------/__-_�-p_--------- Length of each line___f.Z_ ._---y_---Width of trench.-A-'p____________________-_- �6's,"/ T e of filter maferial /FDe th of filter material____ Yp � P te- ---.--._Total length__,e�------------------------------ Seepage Pit: Distance to nearest well____-------Distance frqX foundation___*-".X_,.-__-.Distance to nearest lot line_` --- 14— Number of pits---:_/----_---___Lining material___., 4�e.Size: Diameter__-_- ----Dept -'------------------- Cesspoo€: 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 ------------------•--------------Remodeling and/or repairing (describe):----- ----------� �r/l�[.1�� f---------------------------------------------------------------- .:I -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------- - - I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of +h San Joaquin Local Health District. (Signed)---------------------------J��-✓� -----------------.----------.....----------.-----kce d/ r Contractor] BY:------------•------------------• - -- --------------------(Titl(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be verse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•------ � DATES r REVIEWEDBY---- -- ------------------------------------- ------------------ - --------------------------------------------- DATE-------- ------------- BUILDINGPERMIT ISSUED------------------------------------------ ---------- ----------------------------------------------- DATE------------------------------ ----------- ------------------ Iter tions and/or recommendations--- ---------------------------------------------------------------------------- -------------------------------------------------------------------------- � ��- --ott--------------rte .-------------------------------------------------------------------------------------•--------------------------------------------------•------------ ------ ------- --------------------------------------------------------------------------------------- ------- --------------------------------------- -----•--------------- ----- ------------------------------------'------- -- -------------------------------------------------------- ------- - ------ -------------=------------ ----------------------------------------- FINAL INSPECTION BY:......... ` C... Date-------- ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r F.P.CO. 7��