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FOR OFFICE USE: .. --------------------------- - ----------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ....... ........ .. y (Complete•in Duplicate) S �� ___ ----- -----._--.._--.-_---__.._-----. 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 the work herein described. This application is made ' p iance with County Ordinance No. 5 JOB ADDRESS AND LOCATI N---- fUTf/1. ,�_ - ------- 1+C ----•--•---- - I21__El -�C 6icN E,L/��. one-- - --J Owner's Name r� h- -0- Addressr l= 3 X r1------------- l-/5 y----------------------------------- -- .--------------------------.._..------�.. Contractor's Name------ -----...� ------------------ - ------- - -------------------------------------- --- Phone-------------------------------••- _ Installation will serve: Residence [6"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: _-I-__ Number of bedrooms ,3_- Number of baths-]---- Lot size ----V—C 09-90 Water Supply: Public system ❑ Community system ❑ Private D-�epth to Water Table aD ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q�Hardpan ❑ Previous Application Made: (If yes,date-- ------------ ) No Eff" New Construction: Yes E�r No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: /gaud Z'>rt (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) ID Septic Tank: Distance from nearest well... Distancef from foundation_-___- R�r No. of compartments_.-_...._.: ---. Size_.-7-__A.407 /a-------Liquid clpth___y�-_.. Capacity_-_- --`_v' 2 Disposal Field: Distance from nearest well_64 -_Distance from foundatioW(9_s�_.---------Distance to nearest lot line-0/b- 171 _ Number of lines-_.----___-- _-- -___ Length of each line__ _______________�_f_ Width of trench.__-.c�____ Type of filter material -- - - Depth of filter materia l_---- ---1f_- ____-..Total length---- _-�_7-© ----------------------- Seepage Pit: Distance to nearest well----- ------------Distance from foundation------------------- Distance to nearest lot line__---...____-_--_ ❑ Number of pits--- -----------------Lining material---------------------- Size: Diameter---------------------- Dept h--------------------------------- ,�„ Cesspool: Distance from nearest well _______________Distance from foundation--- ------------- ..Lining material-------------------------------------- F-1 Size: Diameter. Depth - - -L uicl Ca. a.c_i_t,y� _ -----9a-ls. t Privy: Distance from nearest well--------------------------------___.... ....---.Distance from nearest building___-_._-_____________________._---...._. ❑ Distance to nearest lot line _.--------------- --------__--------------------- --------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- - ------ --- ----------------------------•------- ----------------------------------- -------------------------------------------------------- ------------------------- --------------------------- ------•------------_..------------------------------------------------------------------ ----------• ------------------------------------------------------ ------ ----------•-------•-------------------------------------------I------------------------ ------------------------------------------------------------------------------------------------------------------------------- -----------------:- ------------------------------------ ------------------------------------------------------------------------------------------------------------- --------------------------------- I hereby certify,that I ave prepared this apFgy4ation and that +he work will be done in accordance with San Joaquin County ordinances, St laws, rules dyofsf�iem f the San Joaquin Local Health District. (Signed)----- -------- --------------------------------------------------------------------------------- --------(Owner and/or Contractor) By:-------------------------------- ---------- -- --------------------- -------- -------------------------------(Title)------------------------------------------- ------------------------------------- (Plot ----------- ------------ --------- (Plot plan, showing size of lot, locatiorelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATIONACCEPTED BY-- ----- --- --------------------------------------- ------- ------ --- -------------- DATE- .�u J � ----------------------------- REVIEWEDBY------------------------- ---- ----------------------------------------- --------------------------------- DATE ---- --------------------------------------------------- BUILDINGPERMIT ISSUED ---- - --------------------------------------- ----------------------------------------------- DATE.-------------- --------------------------------------------- Alterations and/or recomm aticns--------------- - ---- ---- ----------- - ------ ------------ •---•------------------- ..............--------------•---------- ----------------------------------------- -------- ----- ---------------- ---------------- ----------- ------- -- ----------------------------------------------•-------- - ----..._. . -- ------------------------ - ------ - - -- - ------ ----------------------------------- ........ -------------- ----------------- ------------ - ------- ----I-------- FINAL INSPECTION :. a ....... Date---- --.--4--r.�,2.4 7-------- - --- SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.H Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press