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FOR OFFICE USE: -------- --- APPLICATION FOR- SANITATION PERMIT Permit No. p�f/•�•- -------------------------- ------ --- =------ --------- --------------------------------------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date 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 compliance with County Ordinance No. 5� JOB ADDRESS AND OCA ON..___ ----?` --^ S�iz---- ---- -----------••---- --------------- Owner's Name----------- -- •---- - --------- Address ------ - Phon p_-- A Address_----------------------------- - ---- ----------------------•------ pr �.-------- Phone .= 0, � Contractor's Name_ - �-•�f -�- -- - - - - ` --•. --�� Trailer Mafiek ❑ Other - Installation will serve: Residence � artment House ❑ Commercial ❑ Trailer Court ❑ ` ❑ Number of l ving=4dlt5: !� ber, of,�bedr.©oms Nurrrber.ofrbatlls —_ Water Supply: Public s st6mp Commune system❑ ate ❑Depth to Water Table': t. ` ! 1 Character of soil to a depfhloa 3,feet: Sand ❑ Gravel ❑ Sandy Loal�(� Clay Loam ❑ Clay ❑ Adobe Horde n ❑.� .� :'� Previous A llcatfton Made: (If yes;date-_.................) No ❑ New Cortr ction: Yes ❑ No-)fFHA/VA: Yes ❑ N'o ❑ter TYPE OF INSTALLATION,ANDSPECIEICATIQNS. ,,,,,,.rv,,�,,. h nz%res`' (Nofseptic tank or cesspool permitted if public sewer is available within 100 feet.] ' Se c�Ta�- Disfance from ne ,resfi well--------- - ' d de t apo "' Distance fr m foundation________ ___________Material______._-_.._ �L qit: p Distance to nearest lity...__.__.____ ------�' No. of compartments___-- -----Size___-_._____ — t line. .0- sal i Distance from serest w '_03LQ-�istanof Width ne•.atiOn.: .- --.-.---- --- ' Number of lines---�.___-- :- ---- Length � .Width of trenchc�.�___�_°__- -- T e of filter ma ria Depth of £i1ter material F _ YP Total length_: .f .� d" _ s �„�• -- nc�e T0,�n crest I Of line------ ------ Seepage Pit: Distance t p is re_ 11- _L*Hing ma eria om foundSize:n+D meter_ gist ¢`k` Depth--- ------ ------- Cesspool: Dittance from nearest well__._____..._---_Distance fro foundation_............... .Lming material-______. --------.---------____---. r ❑ �''" ------Depth--------------------------------------------------. Liquid Capacity------------------------• gals. i�e: Dieter------------ ----•----- --Privy: Distance from nearest well_______________.__...__--._.-______--------------Distance from ne rest building_..__--------- -.-------------------- ❑ Distance to nearest lot line--------------------------- - Remodeling and/or repairing (describe)_________________________- �� -----------------------------_---- -- -------------- ___�------- ------------------------------ -------- ---_------ ----•----------------------------- ---- -- � ____ __________________________________________ ________ whereby certify that l'have prepared this application and that the work will be done in accordance with San Joaquin Cunty ordinances, State la and rules nd regulations of the San Joaquin Local Health District. (Signed]- • 6 r -► Contract ... _ __ orj By-------------------------------------- ----- -- -------(Title) (Plot plan, showing size of lot, location of system in relatio o wells, buildings, , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------- - ---"---------------- ------------------------------------------------------ REVIEWED ----------------- ------ --------------- -----REVIEWED BY-------- ---------=---- ------------- --------- ---------•-- -------- ------------- -------------- --------- DATE--------- ---------------------------------------•--------- BUILDINGPERMIT ISSUED----------------------------------- ------ DATE------------------------------------------------------- - Alterations and/or recom Itdations:.__ ------- ----------- -----`- -- ---------- .f �_j/4]_.__.__... -tf�__._ til_ rl__-_.__ -t"-`--~_ _A-___ 3 , .,�, -. ��_ :�--- ----�---�--•---------------•----��-------------- ------------------- -------- -----�------------ - ---------------- Date--------- -f.------- - ----- ------------------------------------ FINAL INSPECTION BY:.._-_ - - -- - -- - --- - �� S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. J