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FOR OFFICE USE: ------------------ Permit No. ------- ----------------------------------------------- ------ ---- --- "��-"--- - - APPLICATION FOR SANITATION PERMIT ------ ---------------------------- ---------- J� '/�� -- ------------ (Complete in Duplicate) Date Issued -------•._....._ ------• This'Permit E)iires 1 Year From'Date Issue 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 ounty Ordinance,.No. 5.44..E .- 1 � -� �-- -------- JOB ADDRESS AND ATI ------- - -- -------- Phone--------------•-------•-------•--- Owner s Name----- ------- p -----------•---•--•- ------•------ Address--------- - -----------------------------••-------: e . Contractor's Name y ' ' ------------------------------------------------------- . Phon -_-----•-----••--•----- - El Installation will serve: Residence ��Apartment House ❑ Commerciai ❑ Trailer Court ❑ motel ❑ Other l Lot size - �!f /s _ ---------------- Number of living units: _:�--. Number of bedrooms _4 Number of baths • _ Water Supply: Public,sysm��ommunity system❑ Private ❑ Depth to Water Table te4 - ft. Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: I Sand-❑ ❑ Y Previous Application Made: (If yes,date"-------- -----=-) No I-II New Construction: Yes [��o ❑ FHA/VA: Yes 9?--No ❑ TYPE OF INSTALLATION AND SPPECIFiCATIONS• ermitted if c sewer- (No septic tank or cess ool public available within_200 feet.) e f Septic Tank: Distance from.nearest well---:7777------ foundation----�i�.-,___-.Mate Fal-----�-�-------• o� ._, 69- -Li uid de th----T---�`------------Capacity- 2--- No. of compartments-•- - /1-------------Size-. -- - ---- q p _-lQ � Distance to nearest lot Disposal Field: Distance from nearest wail---,_=------`Distance from foundatio � - Width of trench- .Z`-------------------------- -15 ----------------- ----- Len Length of each line ----- UK— �-- U 9 Number of lines ---- _ _ - Total len th--� �� ' J a Type of filter material"1 _f �l%k DeptObf filter material-----� ____._-,- - 9 l �� ----..Distance to nearest lot line--- -"" -_ .. Seepage Pit: Distance to nearest'well---_-` '-- Distar�ste fr m fou dation----- -._-. �_� Depth s � (� .size: Diameter-_--.-- .-__ ,Number of pits.__--"�/-.----------1-ming matenal._�� _ - Cesspool: Distance from.nearest well--------------- -Distance from foundation_..-----------:--"-.Lining material_--.--.--."-__.---------__---_-.__--_i -Li Liquid Capacity gals; ❑ q P Y De th Size: 1}iameter--------= ------------------- ------_ p -Distance from nearest building------------------------------------------ Privy-: Distance frorn nearest well-------------- --------------------- y «. -i.-..- --_-:._-I--- ....1 --=_--- ---------------•--••----- ❑ Distance to•nea"rest lot line--__..-"-----------------=` X. ----------- Remodelin and/or repairing describe. = ------------------------------------------------------------ -------------•------••---------------- -----------_ ---------•------- -------------------------- " ------------------------------------------------:-------------- ` -------------------------- --------------------------------•---•------------------- l I hereby certify that I have prepared this application and that the work wit! be done in accordance with San Joaquin County ordinances, State laws; and-rules and regulations of the San Joaquin Local Health District. -- antract (Signed)----------------- - - -----✓ - -----= ----=- ---- ------------ � ] � _- (Title--- ��1,7--'--------- --- -------- -- -- - - -- -- ------------------- r (Plat plan, showing size of lot, locati system in relation to wells, buildings, etc., can bi placed on reverse side). T FOR DEPARTMENT USE ONLY z3-- -------- -------------- � --------------------------------------- i DATE..-----�--•-•-�---- APPLICATION ACCEPTED BY_.:. c : .0= - . ----•--• DATE----------------------------------- REVIEWEDBY---------------------------------------------------------------------- DATE------------------------------------------------------------- BUILDING --- --------------------------BUILDING PERMIT ISSUED :- ---------------- - Alterations and/or recommendations::----- ----=-� --------- 7-------------------------------------------- - •---------------------------------------- ---------------- -- ---------- --------- l---------- -------------- - I FINAL INSPECTI Y:' F SAN JOAQUIN LOCAL HEALTH DISTRICT ` 41—-- 300 West Oak Street i 124 sycamore Street 205 West 9th Street 130 Souk American Street: i Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVIarO 5.59 C.P.C:n.2M"C) I