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FOR OFFICE USE, APPLICATION 'FOR SANITATION PERMIT Permit--No. ------------- ----------------- -------- -------------- -------------- -------------------- -- -- --- ---------- (Complete in Duplicate) i---_-—-.-I—.--.—___..�`- ' '- This Permit Date Issued -- ------- ------ ...... it Expires'll Year-From Oate Issued 4-Application made to the San Joaquin 11� o'cal-Healfh District for-a permif>fo-consfruc*ancl,insta he-work-herein des lbed Tulication-is-hereby- L ,s e with (;oynty Ord' n No. 54-'L__ I ap lication is made in compliance T'IP N - ------- --------- ------------ ---- ------- ------------ -- -- - ----- ---- ---------------- r, on'y rc des "ea, 0 n.. .. DRESS AND J 0 B ID11 .. ------ ---------------- JU ...4_ Phone..._.. �11gi' Owner's Name---------I --- - ------ __ J �;..... ... . ---- ---------------------------------- Address---------------------------------- -------- -------- - ---- ----------------- -------------------- --------------------- ------ Contractor's Nam ..... ------------------------ Installation will serve: Residence ❑ Apartment House [] Commercial El Trailer Court El Motel 1:1 Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --------------------------- i Water Supply: Public system 14 Community system El Private ❑ Depth to Water TabII7-/ _'_ ft. Character of soil to a depth of 3 feet: Sand Gravel 0 Sandy Loam [-] Clay Loam E] Clay 0 Adobe E] Hardpan L] i rOi Previous Application Made: (if yes,date..... .... ........) No New Construction: Yes No El FHA/VA: Yes E] No f TYPE OF INSTALLATION AND SPECIFICATIONS. --(No septic tank or cesspool-permitted- if-public sleris,-avahable within 200 feet.)4;_-4;.-. Septic Tank: Distance from nearest well_-- ---- tDistance from fc,Vndafic,n__J&*........Material ----- I --Z-'4f No. of compartments- ----------kSize_A'5".X,.__2-__8-------------Liquid depth__.--- ------�Capacity_-ATF_5?A;(, Disposal Field: Distance from nearest well _ f-_r_orLnf__o.undatJo0. 1st4nce__to nearest lot line--7-0------ Number of line401 44 - -------Length of each line--/- --.Width of french.36--l-f.------------------- Type of filter material-- ._-Depth of filter material-_---- ----------Total length-- -------------------- Seepage Pit: Distance to/narest well----------------------Distance from foundation---------------------Distance to nearest lot line----------------- V. F-I Number,6f pits----------------------Lining material--------------------...Size: Diameter------_--.-------------Depth-..--.-------.------------------- y s ,� Cesspool: epth-------- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_._..-._-_._------.__-.--_._---_-- ❑ Size:.-Diameter------------------------------------ -Depth------------------------------------------- --------Liquid Capacity- -------------------- Privy: 'Disfan'ce from nearest iwell----------------------------- -------------------Distance from nearest building--_._._.__._____._____________--- -- ---- IDistariceto nearest lot line----------------------------------------------- ----------------------- --------------------------------------------------------------------- t Remodeling and/or%repai:ring (clescribe)_'_ ------------- FT—- ------------- --- --- ------------------------------------------------------------------------ ---------- -------------- - ------------------------ - ---------------- ------------------------------------- --------- ------ Yv---------- ----------- - I--------- ----------- ...... --------------------514 wo_6 4= -------------- ---- ---1A0------A9__T._r1 _j_K0_ ------------------------------------------------------------------------- ----------- --- !!hereby c, fi h rfify that I h !pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and, rule "d regulations the San Joaquin Oal Health District. 'e (Signe'd --------I--------t----- -- -- --- - ------------------------------------ ------ ......(Owner and/or Contractor) _f_sys ,_rn- lot, ocafion n a reverse --- ------ ----- ------- t---------- - ------------=----------------(Title)------- - -------- ------------- --------- (Plot 'Plan' , showing size of lot, ocafion of system n relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPILLCATION ACOEPTED BY-----'F1. r----- --------------------------------------------------------- ------ DATE------..... ------------------------ REVIEWED BY ---------------------------------------------- DATE------------------------------------------------------------ A------ ------------- -------------------------------------------- BUILRING PERMIT IS'SUED---------------------------------------------- ---------------------------------------------------- DATE-----------_----------------------------------------------- Alterdfionsand/or recommendations:-------------------------------------------------------------------------------------------------------------:------------------------------------------------- ---------------------------------------------------------•-'--------------- ------------------------------ - -------- ----------- ----------------------------------------------------------- ------ -- ----------------------------------------------- --------------I--------------------------------------------------- ------------------------------------------------------------------- ---------------------------------------------------------I-----------I----------I--------- --------------------------------------------------------- ---------------- --------------------------------------------------------------------------------- ---- --------------------------- -------------- ---------- -- - ---- --------------------- --------------------------------------------------------------------------------------- -- ----- ---- ---- ------------------- Date------------ --- --- -------- -- --------------------------- --------- FINAL INSPECT11' . .... .. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mozetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C{].