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�.- FOR OFFICE USE: _ --- ----------------- -/I-- Permit No. ------------------ - -- ----- -- APPLICATION FOR SANITATION PERMIT •- �-�-""•• i (Complete in Duplicate) pate Issued - -----`" � e --- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District or a permit to construct and install the work herei�escr This application is ma a i7.3mR ce unt nce / JOB ADDRESS AN L --- ---H/ ----- . . . ' - ---- ----- - Phone------------------------------------ Owner's Name-----,.Vt',Jh--.e --------------------------- ----- ----------- ---�--- - - Address._.__. a a -------------- •A-Tl)-k- - ---- ` Y------I'_ r Phone.------ r Contractor's Name t' x-! ------- ' Installation will serve: Residence R'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel P Other ❑ Number of living units: _f-____ Number of bedrooms _.,,;_-_: Number of baths _L___. Lot size .�L_ 'i_r� -x•- -`y ----------------------- -. ' Water Supply: Public system ❑ Community system ❑ Private E Depth to Water Table _XC.— ft. Character of soil to a depth of 3 feet: Sand a' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ' Previous Application Made: (If yes,date--------------------) No E New Construction: Yes ®— No ❑ FHA/VA: Yes [�q-- No ❑' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer isnavvai available within 2oU feet.) Material--et�_.iiC_ _ _ __ ___ i fO � Septic Tank: Distance from nearest well__J�_-_.________Dista f Capacity-1Z L - No. of compartments-----L--------------- Size �- .. �� Liquid depth y----------- -- I Disposal Field: Distance from nearest well__s�d_�_._-.-Distance from foundation---l�'_�..___---Distance to nearest lot line_ _ __________ , .._.Len Length of each line-------VQ--------- ------Width offrench-----Z---_--_---------------- - �... Number of lines_------�-------------- - 5 . . ------ : Type of filter material----±�Q_�--��......Depth of filter material_.__�_8__-_____.---Total length-------.�_F_©----____------ . Seepage Pit: Distance to nearest well_.___________________Distance from foundation_-__--____-_____-._.distance to nearest lot line----------------- ❑ Number of pits---------------------Lining material----------- -- -------Size: Diameter----------------- --- Depth--------------------------------- 'Cesspool: Distance from nearest well----.--____--___Distance from foundation--- ----_-____----.Lining material------------------- ---------gals, -----Depth_------ -------------------- - ------ ------Liquid Capacity------------------ t ❑ Size: Diameter---- -----=---- ---------- - - " 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 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (signed ' --------------------------------------------------- -----------(Owner and/or Contract By: --By:------- ----< --- ------------------------------------------------- --------- ------- -------- ---------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FPR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____-__ l-� DATE........?__7---------- --------------------. REVIEWEDBY------------ ----------- -------------- --------------------- --------------------------------------------------------- DATE------------------------------------------- ------.--------- BUILDING PERMIT ISSUED--------------------- ----------- ---------- - --------------- ---------- - ------------- ---------- DATE------------------------------------------------------------ Alterations and/or recommendations-------------------------.- - -------------------------- FINAL INSPECTION BY:------ ------ - ---------------- Date.------- =f� ------ ------------------------------------ .... __ _ -�,•.-= --- SAN J AQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West oak street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manteca,California Tracy,California F.R120,