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FOR OFFICE USE: 0."1 � . �: APPLICATION FOR SANITATION PERMIT Permit No. L9.691a._Z, --------------------------------------------------------- (Complete in Duplicate) Date Issued _ This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC`ATION-----I.9_�la------ Sa------- .G�f� E sJ� Owner's Name---- �r�..4(,-_�------- �.r 4 Cr7 ---a--�-----0.W------------------------------------- Phone----•---------------•--------------- Address---------/1 _0---------- c2 1� ------;�!f`_t� ------ - –��o--e o V---------------------------------- Contractor's Name----------� - Ak----------•-•----- ----•--- Phone------------------------------------------------- --------------------------------------------------------------- - Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ M/otel .❑ Other [}--� Number of living unifs:A/t- Number of bedrooms NU- Number of baths. °*A.ot size ------- 1___-_14 ___________________________ Water Supply: Public system ®--Community system ❑ Private ❑ Depth to Water Table --------- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application_Made: {If yes,date__`g No ❑ New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Septic Tank: Distance from nearest well-------------------Distance from foundat.ion/P____._.____.Material AW-Wan No. of corn partmenfs--:.�t---------------Size--------------------------------Liquid depth--------------- ---------�Gapa - �d©� - Disposal Field: Distance from nearest well---'---_---Distance from founclation_10--___-_____.Distance to nearest lot li- Number of lines----,----------------------------Length of each line------- -e---___��-------Width oftrench---9_�--_-__------------------- Type of filter material Rv_[.e�____-----Depth of filter material---f> _---___.____Total length..../_ga_. --------------------- R 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-------------------------.___.______- ❑ Sze:iiameter------ ------------------------------De fh------ ------------------------- - ------------Li uid Ca Capacity gals. D Privy: Distance from nearest well _______________________________..--------------Distance from nearesf building--_._---__---------_--_-_-___...____.___. ! ❑ Distance to nearesf lot line ----- ------------•-- - --------------------------------------------------------------------------------------- I / Remodeling and/or repairing (describe):----S�[ 1___.-__---- -____,5 2 �`__-____ ._ �_r -------/�L--rS f �$t,v r -- --------- ---------------- ---------------------------------------------------------------•--•----------------------------------------------------------------1--,-----°—---------------------------- w --------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------:-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San;Joaquin County ordinances, ws, and ule and r gulations of the San Joaquin Local Health District. y J, s --- ----- _-- -- ---- ------------------ and/or-- ---------------------- -----( - k By:---------------------=----------------------•----------:--------------------------------------------------------- (Title)-----,*. o ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED I3Y- --- ----------------- ---------------------------- DATE-------------�-------- ------------------------- REVIEWEDBY------ ----------------------------- ------------------------------ ----- -----------------------------=--------------• DATE-------------------•--•----------------•---••-----•-------- BUILDING PERMIT ISSUED---------------------- - � -- - ---------- ------------------- -------------• DATE--------------- Alter i a /or recommendations:-____- /_ _/..d --__--_- _ _ r / _- - t. �;_ ---- --------------------------- -----.., .----- - -------------------- - __- ' Y FINAL INSPECTION BY:.- G�/ ----- ----- Date-- ----------- ----------- SAN.JOAQUIN LOCAL HEALTH DISTRICT 1681 E,Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.QQ. f