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FOROFFICE USE ihw1017 �r -------------------------- ------- --- ----------------- APPLICATION FOR SANITATION PERMIT Permit No.671.46_8--? ------ --- --------- ------------------------------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued bate Issued __ Application is hereby made to the San Joaquin'Local Health District for a permit to construct and install the work herein described. This application is made in camplia ce wi+ C or 1ancXNo. �Z r��s�I,nlL P.yit�f F�aYCcPJ R p - -�.�.- Ul/ -0 F- [aiv 0 N RP. JOB ADDRESS AND LOCATION_ ,___ ..__ _ /1/1TCY--- Owners Name--------r�- <- ---------A_(, 2 _-� u.- Phone./.,Ac_ Address r ..-----C-�- ----- ---------------------.-------------------------------------------------------- ' Contractor's Name---- — --• - - f - ----- ---- --------------------------------------- Phone__L_ ---------------- Installation will serve: Residence E�- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms _1__._ Number of Baths —7----- Lot size ___:__ _____________________________ r f Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -ft.Sf !f 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 Ki' New Construction: Yes [g" No ❑ FHA/VA: Yes [n" No ❑ -__TYPE_.OF INSTALLATION AND..SPECIEICATIONS:, i _ (No septic tankorcesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Well-S_-a_`____.Distance from foundation_.._"'_--___._,.Material__��.----"'-----�_.�_____________ No. of compartments___.i..___._____.._Size_�Y__�__14__S__-----Liquid depth___�'_.-__.__--------Capacity_Js __Q_ Disposal Field: Distance from nearest wedl_.S__©_-_ .Distance from foundation__1_0----------.Distance to nearest lot line_________________ 0� Number of lines---------z-_______�________._Length of each-line_____;____ ��_.---Width of trench------Z.---�__________________ Type of filter material----4a-<.I_----Depth of filter materia ...... length_____15 4_______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------- Distance to nearest lot line-----------._-..- Number of pits--------- ------------Lining material----<rr-._._._.......Size: Diameter---------_---------------Depth--.------------------------------ Cesspool: Dis a from nearest well-----------------Dista nce from foundation------------____..Lining Material----------------------------------- ❑ Size: Diameter-- -- ----------------------------Depth----------------------'------ ----- ---- --------- Liquid Capacity- -_------- --------------gals. Privy: Distance from nearest well----------- ------ -------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line------------ �� 5< ------•----------------------------- Remodeling 'and/or repairing (describe :--- - ----------------------------------------------- ---- ------------------------------ •------------------------ -----------------------------------------�- #.. ---- F-13�-----5-AN-0�........... DI�-- ------ --- - wRT - 'fB-�.-- .SEA - -----�1-r�ISS �14.+E N ^/--- i/ R i_E:z5------1 i p7H 5'H_N p nM Y--�NF,c iT�iA t- R?�- -�"�t--- ---- 1/+� - Tt_ri 'T= 1 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 regulations of the San Joaquin Local Health District, (Signed) -- ------- -- ------------- ------f t--------------------------------------------------------------------------(Owner and/or Contractor) �. --------- '_Title (Plot plan, showing size of of, location of system in relation to wells, buildings, etc., can be placed on reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -_-.{--- �1 A --------------- --- ---- -- ---------------------------------------- DATE------.�__3/- ----------------- - REVI£WED BY-------------------------------------------- ------------------------------- - -----•--------- ----------- ----------------- DATE----------------------------------- - '` BUILDING PERMIT ISSUED----------------------------------- -------------------------- ------------------------------------ DATE-----=-------------------- Alterations and/or recommendations------------------------------------------------------------------ ------------------------------------------•----------•--------------- ---•----------------- ----------------------------------------------------------------------------------------------------------------------------------------•-------------•--------•------------------------------- ----------------------- FINAL INSP ION Date._r______________lJ� Z �� ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Sheet Stockton,California Lodi,California Manteca,California Tracy,California , F.P-C o.