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FOR OFFICE USE: --------------------------------------- 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 and install t work herein des rbed. This application is made in compliance with County Ordinance No. 54 �� ��pp - - SOB ADDRESS AND L CATION._, 4 6J.016 6 Owner's Name Address------- � R°/ �i ----------------------------/---�---y-------------------- - - -------------------- ----- - ----- Phone------------------------------------ .. � F>Lrlll<f------------------------------------------------------ Contractor's Name------ / _/c ------------------------------- • ----- ----- Phone----------------------------------- Installation will serve: Residence PoO`Npartment House ❑ Commercial ❑ Trailer Court;❑ Motel ❑ Other ❑ Number of living units: _Z__. Number of bedrooms S__ Number of baths Z____ Lot size .4?61*. _______________________________ Water Supply: Public system ❑ Community system ❑ Private JR-Tepfh to Wafer Table 0 ft. 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 &-- New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No 2�+" TYPE OF INSTALLATION AND SPECIFICATIONS: — '�(No septic tank or cesspool"permitted if public sewer is available within 200 feet.) Septic Tank:, _ Distance from nearest welf_____ __________Distance from foundation--------_-----------Material-___._.___-_._____-._____..._______._..-------_ t-P MA No. of compartments Size Liquid depth ----Capacity----------------------- 7� Disposal F,iel Distance from nearest well___ a-Distance from founda�o __� .`_.__.Distance to nearest lot line--° ------- a/-t ________ p� Number of lines- ----'-------- ---- -------- Length of each fine__�___A__-}}- - Width of french�r••,---------.------------------ �. Type of filter maferia V_A�_ p Iter material__/ - r ��//� De th of filter Total length-- ' -----•----------------••_--- sC Y - -- teepage Pit: Distance to nearest well----------------------Distance from foundation___________________ Distance to nearest lot line______'.__.______ ❑ Number of pits----------------------Lining material-------------.---- ----Size: Diameter---.---'---------- -----Depth--------------------------------- �!1 Cesspool; Distance from nearest well----------------- from foundation--------------------Lining material...--------------------------------- 171 __.._.____....__---- _________❑ Size. Diameter---i------------------------------ ---De th------------------- ----------- - -------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest,well------- ----- ---------------------------------Distance from nearest building---------.-------------------------- ----- -.❑F1 Distance to nearest lot line ----------------------- - ---------------------- Remodelin and/or re air;n describe r -------------------------------------------------•----•------------------------------------------------------------------------------------------------------ ------------------------------------------------------------- - ----------------- -------------------------------------------------------------------------------------------- - - ------------------------------•-------------------------------------------------------------------------------- 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 regul�atiioo�nss off e S n Joaquin Local Health District. (Signed)• --------- `r !/�"t lo ------------------ - --- -- ------------------------------------I Contractor) ; . ----- (Piot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___. f__ :.. -�...___ ff DATE � `�.�- ,�.IC�'--- ---------- REVIEWEDBY--------------------------------------------- ---------------------------------- ------ ------------------------------------- DATE------- BUILDINGPERMIT ISSUED------------------- ------------------------------------------- ------------------------------------- DATE Alterafions and/or recommendations:-------------- ----------- -- - ------------------------------------------------------------------ ------------------------------------------ -------•----------------- --------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPEC --- ----- -date-------------- i�`. .. 116-6_' SAN 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