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FOR OFFICE USE: �� --__--..-___ _____________ _3_i-y,_---. APPLICATION FOR' SANITATION PERMIT Permit No. I --- - �... (Complete in Duplicate) �i '. - .�.t- -�` `� TFiis Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and,install t ork herein descry ed. This application is made in corwliance with Cotoy Qrd• an Vo. 5 �C" �p� A JOB ADDRESS AND LOCATIO�_(rf/i---,S i. ----0,,�- f� , ��-------- Owner's Name_ .___ ----------------- ---- --------------------------------------- --------- _ Phone Address__ _ ------ --- ------ . -.�� Contractor's Name ------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House W-c--ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms -_ Number of baths __ Lot size ------ Water Supply: Public system ❑ Community system ❑ , Private �epth to Water Table ' Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date _..__...._.,._°..__.f N0.�_ New Construction: Yes �Vo E] FHA/VA: Yes E;. E] TYPE OF INSTALLATION AND SPECIFIC_T10NS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 -. , < l Septic Tank: Distance from nearest well:"_ P ._Distant/e from_foundstion_ �________.Material._�r --------------- No. of compartments. _- Siz �'X aC Liquid depth__.. ..__Capacity,/2-1 Disposal Field:. Distance from neares well / .Distance from foundation—00 Distance to nearest lot line Number of lines_._. _--_____ _ Length of each line-*-`_-_._--"--.--_--__Width-of trench_________________________ Type of filter materialv,,!A;4 _'�De th of filter material_-- - g y -----" p �� dotal len tfi_ See a e Pit: Distance to nearest well- ` Distance #r m fo ndation__ Distance to nearesfi lot line P g s� e. /`y ----- - -------- Number of pits___ _._..._..___Lining materia f -.Size:k-6iarneter _______, Deptn4V - ,�_.._ Cesspool: Distance from nearest well-----------------Distance from foundation..----------------- Lining { . Distance §' mater ... _..t--,----,----------------- --- ---------- TiDiameter ------------- ---------------------- -Depth------ -------------- --- -- r -_--__Liquid Capacity-------- gals.. Prrvy• fromneo�est well------------------ ------------------------------Distance from nearest building---------.--�----•--------------------- + `❑ Distance to nearest lot line -------------- Remodeling ------------ -- Remodelin and/or repairing de•s ribe :------_-_�' - ---------------------------------- ----------•--------------- g - / P. 9 1 "u - G - y �- -------------------------.---------------------------------------------------------- ' ------------------------ - ---------------------- ------------------------------------------------------------------------------------- �k I ._ _ _ _,_------___-__ .__-_-_-----__-_--_--_-��-`_______________.-_------___-____-_____-___--_--e_------_.-_'----------_ ) ---.--__-; --------- ----------------- --..---- - -- - - ------------------------------------------------------------ I hereby certify that I have prepared Ais"application and that the work will be, done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. ) I (Signed)--------------- --•------ - -- ----------------------------- ----- ------------- ----- ` .fes Contractor) I B t v-------- etc T' ) I -- ---- (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc. cart be placed on reverse side). t r e FOR DEPARTMENT USE ONLYI_ APPLICATION ACCEPTED BY_ G3 _---"_____________________________ DATE----- - f ------ f .REVIEWED BY------------------------------------- ------- -_ DATE BUILDING PERMIT ISSUED--------------------------------------- - --------�------------------ -------------------- DATE. - Alterations and/or recommendations•-"-"_..Lf_ ". h_1 �_ _______________ �i+� .r. �- M =F •--------------- ----�f--�'------- ��=�---�- r -- --�""-s-�--=--------=--- �K - ------------------------------------ I --------------- /'-`` G,,� _ r ��c- Y ----- - �--- ----------- --------- y ------ - ------ -- ---- ------ f ---- ----- FINAL INSPECTION BY:-- i' ------------- _1_4K Date _r� r� � rSANJOAQUIN LOCAL HEALTH DISTRICT 1601 F.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street r Stockton,California 4 Lodi,California Manteca,California Tracy,California F.P.C C.