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r'UK Urric.t USt: ----------------------------------�..-- ----, APPLICATION FOR SANITATION PERMIT Permit No. . ------------------- ------------- ---------- ------------ (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a install lre work herein described. This application is made in compliance with County Ordinance No. 54 . if JOB ADDRESS ANDATI - ------------ ___ w "' Owner's Name------ n r Address__... . i -- --- --- e-------'-�`-------------- d--- II- Contractor's Name--- - L-- �-`�_1- Z-77;__ 1 -------------- Phone-_�� ------------ Installation will will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __._ Number of bedrooms .__umber o aths .__ -_ Lot size _ ---__/_1------/ .---0---------- Water Supply: Public system [-] Community system E] Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel Sa dy.Loam ❑ Clay Loam ❑ Clay ❑ dobe K<ardpan ❑ Previous Application Made: {if yes,doteZ_ '"! } y� Construction: Yes ❑ No FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se - i Distance from nearest well-----___.-------Distance from foundation------------ ---Material-_-------___ --------------- -------------------- No. of compartments ------. Size--------------------------------Liquid de t ------------ ------------Capacit ------------------... I` y ?,► Mo Distance from nearest well_ Q----Distance from founda ion--��---_-.Distance to nearest ofNumber of fines __Length of each lin __ U Width of trencType of filter materia _ -Depth of filter material....._!.-----r Total length_-_-__-.-________- Q_Q__-� Seepage JUf Distance to nearest well -______..__ _Distant rom fgundation____!. Distance to nearest lot line-----.U____... V�,J Number of pits---�------------- ___Lining material_- Size: Diameter_4�_ . _--7(. -r---- Depth----- ---- ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------.___---_-_..__ ❑ Size: Diameter----- - ---------- -------------------Depth------- -------------------------- ----------------Liquid Capacity------------------ gals. Privy: Distance from nearest well___-------------------------------- --- ---------Distance from nearest building------------------------------------------ 11 -__--.___________--_-__-_ .-.-__---_-..__❑ Distance to nearest lot line-- .-.. Remodeling and/or repairing (describe): - -------- - ---------------- --- -------------------------- -- -------------------------------- ________________________ ______------_-___-_-.-------_--------_ __:___ _ = :_ _ _ ---- -- -__---------- __:: - _ _ _----------------___. :_ ------ ----------------------------------------------------------- n - 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, rules and regulations of the San Joaquin Local Health District. (Signed)_____ --------Z, , ---------------I- ------------------- - or Contractor) By:29,15-F--ah- ----------- -------=--�ZV4Q�ZV4QE--------------- ------------- - -------- ------ ------------------{Titleiced - - ---- - ------ ---- ---- (Plot plan, showing size of lot, Iocatior bf system in relati to wefts, build' s, etc., can be on reverse side FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---------- ---------------------------------------- DATE------<T__ - REVIEWEDBY---------------------------------------------------------- ------------------------------------------------------------------ DATE---- BUILDING PERMIT ISSUED-------- ----------------------------- ---------------------- --------------------- ------------------ DATE------------------------------ ----------------------------- Alterations and/or recommendations---- -- ----- ----------------------- --------- - ------------------------------- ----- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------- ----------------- -------------------------------------------------1-1------------------------------------------------------- ---------------------I---- FINAL INSPECTION BY:_ . ------ Dafie__... � ..-- ---------------------------? - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 Wrest 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.F.C❑.