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APPLICATION FOR SANITATION PERMIT Permit No. _--140.7.41 (Complete in Duplicate) // Date Issued :�I�_��______ Application is hereby made to the San Joaquin Local Heal+h,Dis1rict for a permit to construct and install the work herein described. This application is made in cornpliance,wifh�County O'rdinanc 1. JOB ADDRESS AN CATI N-.-.-- ---- j-'�.�----- ,� : ---- - - ------------------------------------- Owner's Name - ------------------------�'-= Phone-------------- - ------------------- Address.- - ♦� ----9------- Contractor's Name-------------- --- --- ----- --------------------------------- ------------------------------------------ Phone------------------• -------------- Installation - •-------Installation will serve: Residence �Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • ,ta r Number of living units:.- -_ Number of bedrooms _A-r- Number of baths- ---- Lot size'-fr� _�` �A-459--,___------------- Water Supply: Public system;❑ Community system ❑ Private Depth to Wator Table 07 ft. Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Clay ❑ Adobe R--Vardpan ❑ Previous Application Made: Yes No ! pp .i ❑ [ New Construction: Yes �o ❑ FHA/VA: Yes [s�1�Eo ❑ ' 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-147-v-____.Disfancejfrom,foundafion__-_/— --------Material---- -_K_ ►a � -- y----. �� No, of compartments..... . ..........--__ Size_t __; -�__Liquid defth.___ __. ------_-Capacity__ _ 4 , Disposal Field: Distance from nearest well__�Zf_._. Distance from foundation A� -___-_--Distance.to near.est lat_line______________ Number of lines----------- --- - of each ]ine______._'q �, --Length ,r ----------.Width';Of french---- -------------'------ T e of filter material _1 -De th s �� ._ -_- --- Iter materiial__-_- . !._-_,----..Total length---------- .- _G-- V Seepage Pit: Distance to nearest well /0- Distance fr; m fo dation �_ Di a W to nearest li e___ \(�t [ � Number of pits Lining material-_ -Size: Diameter--- - p De th Cesspool: D'stance from nearest well-----------------Distance from foundation.-------------------'Lining material------------------------------_=_.---. \ ❑ Size: diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from 'nearest bui#ding_-_-----_-_________-__---____----_-_--_-. ❑ Distance to nearest lot lire---------------------------------------------------------------------- - ----------- i --------------------------------------------------- Remo e ing and' e) . ------------------------------------------------------ or rePa�nn9describ 11 ---- --------------------------- -- --- ----- --- ---------- ------------- ------------------------------- ---------------------------------------------- ----------------------`.----------.---------------------------------------------------------------- '` I 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-SanJbciquin-La:cal-Heaitk-Disfrict. - (Signed)_ - -i__-�- -- - --_._--- - -------------------- (Qwner_&nd/er Contractor) 11 By------------------------------------ e�� `-----------=--------------------��itle} /3�� -� �=------------------------- (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y------ !>-----------------------------------------------------•-------------------- DATE--------- REVIEWEDBY------------------------- '1 -------------=----------------------------------------------------------- DATE BUILDING PERMIT ISSUED-----'--------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:-------------- ----------------------------------I------------- --------------------------------------------------------------------------------------------- -•--------------------!!P17------- f} 5 --------FM$ ---------------- � hC Ll l_ vl'` f CT�f.Qr`i� S t� f 'f r �--------'7----r ---�'�--------------- -----------•---•--- -------------------------------- -- ----------------- ------------------------------------------- I FINAL INSPECTION—BY:. a - Date-- TS SAN JOAQUIN LOCAL HEALTH DISTRICT E30 South American Street 300 West Oak Street ''.1 � �,1?2 Sycamo�relStret 1 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revisea 1-57 F.P,CO.