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FOR OFFICE USE: / I ---------------- --------------------------------------------------- ---II' APPLICATION FOR SANITATION PERMIT Permit No. ___z J_0.7 -- ----- -------- ------------------------------ I: (Complete in Duplicate) Date Issued --------_---_ - - _ This Permit Expires 1 Year From Date Issued Application is hereby made to:the San Joaquin Locaf Health District for a permit to construct and install the work herein described. This application is made in colmpliance-with County Ordinance No. JOB ADDRESS AND LOCATION...---- -------- -- ------ -- Owner's Name---- /��.� 5 .� -------------------------- --- Phone_,44(p__3.�4--a---- Address--------------------------t1` l Contractor's Name----------------------•----------------- •---- Phone- 4 � �----�--------sem,-�-_----. _ �r�_.�---"--. Installation will serve: Resid nce$, Apartment House E] Commercial ❑' Trailer Court ❑ Mote! El Other ❑ V ___ Number of bedrooms _ I Number of living units:.,__1_ t�_ _ Number of baths _'__._. Lot size ___��_7�___�,��___________________________ Water Supply: Public system. , Community system ❑ Private ❑ Depth to Water Table 00 ft. j Character of soil to a depth o�F 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ ` Previous Application Made: (If yes,date._"---"-------------) No A New Construction: Yes ❑ No P< FHA/VA: Yes ❑ No X TYPE OF INSTALLATION AN D SPECIFICATIONS: f �R (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s �I, Septic Tank: Distance from nearest well________________!!Distance from foundation____.________.__.. Material------------------------------------------------- ❑ 1C,15J-tAq No`. of compartments-------------_ ;--Size-------------------------Z___,"..Liquid depth--------- --------- -----Capacity----------------------- Disposal from nearest well./v6A10 _Distance from fou'r}dation_ Disposal Field: t � ` _ _ .3 ---------- to nearest lot F - line e___J�______ Number of lines__� �C�[� Length of each line----- -- --- �-----...Width of trench---�-4 -r+------------------- Type of filter mate ra_ ; QDepth of filter mater ___Total length__:-----6 7V---_--------------------- Seepage __________________.-Seepae Pit: Distance fo t5earest well_AMW _Distance m f ndation__3J6____. Distance to nearest lot line_.f1�_.__ i Number o� p.its_jl'te.�J j---Lining material"" Size: Diameter__ Depth--.. Cesspool: Distance from nearest well___y___.__..___7Distance from foundation_________--------___Lining material_.------------ ---------------------- El - ------ ___-_ t Size: Diameter:--`---�------------- ❑ � .�I. s _ p - ------ --------------------- - -------- --------Liquid Capacity---,-----------------------gals. `. _.._ Privy: Distance frominearest well_____.________._.__`_ ____________-------------Distance from nearest building--------------.____:_______'.._____._._. ❑ Distance to nearest lot line------ ---------F ----------- -... ,: = f I , f Remodeling and/or repairing (describe):-- P � �� - ��_�� ` - •--0----------- -------- ------------------------ ----------------------------- -------•--------------- a --------------------------------------------------ilf' ---------------------------------------------------------------------- -- - -- q. I hereby certify that I fres avrepared this application and that t. work will be done in accordance with San Joaquin County ordinances, State laws, andand regulations f the San Joaq Local Health District. (Signed)-------_------------------ - ------ (Owner and/or Contractor) BY� --'.' -` (Title) - (Plot plan, showing size of lot;location of system in relat n to wells, buildings, etc., can be place n reverse side). FOR DEPARTMENT USE ONLY k 9 4 APPLICATION ACCEPTED BY' ��-�i-- - -------- ------ ----------- ---------------------------------- DATE----------9 11k, ...--... REVIEWEDBY--------------------------j ----------------------- ---- ------------ -------------------- --------- DATE------------------------------------------------------------ . -- D T Alterations and/or recommendations:- 1 .. . . __. -------------------------------BUILDING PERMIT ISSUED---1------------------------ y� d �� r - V_d---af-----------------------------------•---------------------------------------•------------------------- ---------------------- ------ I --------------------------------------------'--------------- ------------- ----------------- ----------------------------------------------------------------------------------------- FINAL INSPECTION BY:_-)Y � r'�-�- Date .. ._--� l �� --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street # Stockton,California Lodi,California Manteca,California Tracy,California F.P...0 17. t