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FOR OFFICE USE, � F ------_______________ APPLICATION FOR SANITATION PERMIT Permit No. ... 5� -------- --------- =--------- (Complete in Duplicate) ��jj ZS` ---------I.................... ..... .................... This Permit Expires 1 Year From Date Issued L./ Date Issued ___l _____ _ 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 compliance (with County O,rddi'nance No. 5.4(9. /� P4.-Mm JOB ADDRESS AND LOC T 0N-------!_6-6-------------,1/iV4-rc�-�-d---------Av-P------------------- -----------•--- ----------RT'C�--- Owner's Name--------------------- �1...�-F -T----•----/'/�--u-�.-"�' Phone..--------------------•------------ 57-�"f---------v©------- 7P�.�-------S ------ 74... a THQM(Son/ CAr-ry! Address-------------------- - Contractor's Name----rMTCI------- T 1 --------- ....... ------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: ....V Number of bedrooms_____ Number of baths 1_____ Lot size -,/_�...... ----------------------------- ! Water Supply: Public system ❑ Community system ❑ Private Wr"bepth to Water Tablel47--- it. Character of soil to a depth of 3 feet: San4:.Q Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------- ------) No KT"�New Construction: Yes ❑ No 6--._FHA/VA: Yes ❑ No 0_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-- -----------------Material_..-_-___-___...__-______..___.____________-_. -rfn1C No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field:� Distance from nearest well..---5-0_-__Distance from foundation----�V-_.__.__.Distance to nearest lot line----�7.-_. � F-,Kl Number of lines---------------I----------_---- -Length of each line------9__--c,--Ft-----.Width of trench-------- - _------.------.-- '� Type of filter material---� _LI ____Depth of filter material length 6 Seepage Pit: Distance to nearest well-----�--0------Distance from foundation____l_Q________-Distanc to nearest lot li e----cS�` [i Number of pits.---------t...___.___Lining material__ ® K,_.Size: Diameter.__x__�.----Depth____- _9------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------.---------.-_._-___------_.--_. ❑ Size: Diameter--------------------------------------Depth------- --------------------- -- Liquid Capacity-=--------------------------gals. 9► Priv Distance from nearest well-------------------------------------------------Distance from nearest building.. to ❑ /f! Distance to nearest lot line--------------------------------- ----------- ---------------------------------- ------------ ------------------------------------------ Remodeling' and/or repairing Edescribe]:....EXt51-1-r4C-r---- —e#4C-f-1-A)-nfF-j------1V�-----�-----C_VL> -------- 0 --------- trvS f PR1E.�n_ NF-Ps�-------------- -------------------------------------------------------------------------------------- ---- ; ---------------------------------------------------------------------------• ----------------------------------------------- I hereby cer ' y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e aws, d rules egulations of the San Joaquin Local Health District. (Signed)---- - _.-- �� ------------------------------(Owner and/or Contractor) BY (Tttle)---------------------------------------------- ------- ------- ---------------------- ------------------------------------------------------------------------------------- (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-.----- ----------------------- --------------------------------------------- DATE--------- REVIEWEDBY-------------------------------- - ---------- ----- ---------------------- --------------------------------------------------- DATE------ --------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations----------------- ---------- -- -- --- ------------------- ------------------------------•--------------•-------------------------------------------- ----------------------------------------------------- FINAL INSPECTI BY /yh! i<' ( , Date------------------!_ � -------------- -----------. SAN.JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi,California Manteca,California Tracy,California