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R SANITATION PERMIT Permit No. -9 APPLICATION FOR (Complete in Duplicate) /'r/ d. G P � 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. �� " -- ��1/ � JOB ADDRESS AN OCATION---- ____. -____-___ - / ------------ Phone -- - '�- --X_� Owners Name------- - �----- >�7 Gcr" .A J_-�'n/------- ---'�- -------- -------------------------------------- -------------------------------- Address--------------------�1�Z'�-7------ f f�7 ----------- Phone ��`-- f; Contractor's Name_____- __[2_ __�?___-_-__ _ Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living unitsNumber of bedrooms ---j--- Number of baths "_j___ Lot size ----- � -- Water Supply: Public system ❑ Community system ❑ Private epth to Water Tablet,53- ft. ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay E] Adobe Ej No ,,,.., fNew Construction: Yes ❑ No [ A/VA. Yes❑ No � V Previous Application Made: Yes E] 1.J' TYPE OF INSTALLATION AND SPECIFICATIONS: v (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic TqDistance from nearest we}I-----------------Distance from foundation___________________Material_-_.__..-____..--._________--____-_------------- No. of compartments - Size--------------------------------Liquid depth--------------------------Capacity---------------------- M----___-_.Distance to nearest lot line____lAV_____- • t Distance from foundation____-____ „ r Disposal Field: Distance from nearest welL �a-- ---- OWidth of french.-____-� --------------------- Number of lines------------—---------- --- Length of each line______2 -----------------..�� Type of filter material p_ � --Depth of filter materta!____.l _._-__-___Total length.._____..______t___.� I Seepage Pit: Distance to nearest well----- __0_a_�.4_Distance from foundation___.-I _,_:f'.Distance to nearest lot ine_.-______.______ , ! ��/ Number of pits-------- Linin material__3..tr' —...Siryze: Diameter------ Depth______- -__, 'i9Jlc- � —2.. , Linin material__----A -�----------- Cesspool: Distance from nearest wei Distance from foundatio _-_____ :__Li uid Capacity__.__--________---__-----gals. Depth------- -- - q ❑ Size: Diameter---------- �-- ------------- 001 Distance from nearest well-------------------------------------------------Distance from nearest building----_____-___--____-____---_____.-------. q Privy: --------- ❑ Distance to nearest lot ine_____-._______._------------------------------•--- 1 _ _ - .c _c� .---•---------------------------------------- ------ ----- Remodeling and/or repairing (describe : -------------------------------- ---------------------------------------- -------- --------------------------------------------------------------------------------------•----- S --- u --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of he San Joaqui cal Health District. .^ " Contractor) -U - -- -- (Signed) _ - (Title)------ - ---------------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY ---- DATE - APPLICATION ACCEPTED BY DATE -- ---- REVIEWEDBY---------------------------------------------------- - :-.---------` DATE . ------------------------------------- BUILDING PERMIT ISSUED --- -- --------------- ------------------------------------ Alterations and/or recommendations___________ ___ ----- ----•-------------------------------------------------------------•--------•--- ---•-•--------------•----------------------------------------------- ---- ��--- l� C - ------- ----------- --- ----------------------------------------------- ------------------- - ------ - ,�� _ Date---- -------- -------------- ----------------------------- --- -- ------ ----- FINAL INSPECTION BY:.. -- - ------------------------------ -- SAN JOAQUIN LOCA HEALTH DISTRICT Sycamore,132 5 Street Y 014 Nbrth '•C" Street "' '•-'--- ``a:*. � •� ' ` ' ' 134 South Ameriean Street 300 West Oak Street. `�' Trac California I Stockton, California Lodi, California Manteca, California Y. r - a ES-9-2K4 , Revised 1-57 F.P.CO.