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FOR OFFICE USE: I -------=----------------- ------------------ / --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _1�u: ..lJ. (Complete in Duplicate) t y Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a p o•eonstructrand install the work herein descr This application is made in compliance with County Ordinance N . 54 . �... -' +r% k;g Ai JOB ADDRESS AND LOCATION �l _ ...:.,., f::._.. . _� ..... `eAtAt'L o -•-•• ------Owner's Name. ...-•------•---•-----... •-- Phoney�D- t4�74. .. Address_............................ J _- l p�'Ofo• •-----••---------•----/---------•--- Contractor's Name......................•-----.. �'. � ............................ -•--- Phone Installation will serve: ; Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # Number of living units:/_____ Number of bedrooms x?.. Number of Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table l ,t�Q. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ !Adobe❑ Hard- ,in❑� Previous Application Made: (If yes,dote....................) No ❑ New Construction: Yes C] NoFHA/VA: Yes [I No Q s TYPE OF INSTALLATION AND SPECIFICATIONS: II I • r r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) •1•, r~ e •crTank: Distance from nearest well.-...............Distance from foundation-----------.........Material_._.___-____-___---__----___------------•----.'`� No.•of compartments..........................Size--------------------------------Liquid depth...I------------- -•-- Capacity--•---------------e , Dispos Field: Distance from nearest wellS'd......"-.Distance from foundatiyon.O�Q____-____.Distance to nearest lot I;ne._•�Q._.. Number of lines...../_________________________Length of each line...j_A.�?_...»......Width of trench----- �_... ------------ Type of filter material p -------T D t.��l�___.De Depth of filter material____ $___- Qtel length___________________ ___________....... i Seepage Pit: Distance to nearest well----..................Distance from foundation....................Distance to nearest lot line---_.............. ❑ Number of pits----------------------Lining material........................Siz��: Diameter r Depth................-----•-•---- --. Cesspool: Distance from nearest well--________--_--Distance from foundation....................Lining material._-_______--..._____--___.._.._....__; ❑ Size: Diameter.....-----------_--------------•- --Depth-----------------------------------------------------Liquid Capacity-----------------I- 9alsj Privy: Distance•from.nearest well....................-------------------__--__-...Distance froin nearest building__.......____________._�_.__- ;.-...J ❑ Distance to nearest lot line............................................................ -------------••----•--•-•--------. . •-•-----•-- ---•- .- ---•----• ................ "'goe—--- Remodeling and/or repairing (describe):... .__-__ .__- -- --..................................................:.Y._...L.-^�....r_*............_.............._.____._..--.-__.�.....--___......... I hereby certify that I have prepared this application and that the work willJbe done in:accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Locat'HeAth Districct. (Signed) - - caner and/o t Contractor) Title ............................................. =-- - ( ) (Plot plan, showing size of lot, location of system in relation to�w� , llodildings, etc., can be placed on reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- 1r � :f- --- - ----------------•------_-• DATE............� t7 REVIEWED BY_-------_ - - - ----------- -- --------------- DATE-------------- ---- It - -- - ------------------------- BUILDING PERMIT ISSUED---------------• ------------------ ------------ ---------•----------- Alterations and/or recommendations:--------_--•-.------ 't ---.- •-••---------------------•-- ----------••----------------------- d'......••------------------_-------------------------------------------------1 ` .------•---•-•-•--•-•----•----••-•---------------�---•--------------•••......-•------_..... ------------------------•--•-- --.---------------------• _...---------•••----..........---.......•--•• .... ------- -------•--•-------•••• -------••-•-------••••-------•-------•--•-•---------------------•-•----------•----------•- FINAL INSPECTION BY--------------- ----- --------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California