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FOR OFFICE USE-. 2CD - --------------------------------------------------------- _-_____._._____________________._.____________.__ APPLICATION FOR-SANITATION PERMIT Permit No. 9-4?Z..... ------------ -------------------------------------------- (Complete in Duplicate) .__________________---_-.--_____.-_-._.-___. 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAION Z� NO--------A-c-4o-1 } Owner's Name--------------------- --------- -� ?Q-/�1---------------------------------------------.----------------- Phone.................................... AddressNQ -----------------------------------------------------------------------------•-----------•------------------------ Contractor's Name-------Q _ =--•-----•----•-•---------------------------------------•---'- ----------..... .............. Phone................................... Installation will serve: Residence (Apartment Mouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _____ Number of bedrooms 3--- Number of baths _1.._. Lot size ----�,4 1 ... __________________________•-_ Water Supply: Public system ❑ Community syst I-] PrivateDepth to Water Table . a ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sand Loam E] Clay Loam E] Clay E] Adobe E3 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ 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 foundation--------------------Material---._______-__-.___-_--__________--_._._----___-. EDOST-1 NC?'- No. of compartments--------------------------Size--------------------------------Liquid depth------------- ------------Capacity----------------------- Disposa"T,l Fiel Distance from nearest well---5Q_...Distance from foundation-__1Q-__-_.--.Distance to nearest lot line-__tT--_--.. C—, Number of lines----------- /. __-.-Length of each line____ r ` F 9Q ----- K .:Width of trench. - VD - Type of filter material__. DC__ yp . .___Depth of filter material-----1��_ -----:_.Total length_________________,?�__�__-___..____ 6 Seepage Pit: Distance to nearest well--.------------------- from foundation---------------------Distance to nearest lot line._-___-__-____-- f ❑ Number of pits-___--__-_.._-___Lining material----- ------------ ----Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.---____--_.___.-___.__.-_--_---_. z ❑ Size: Diameter-------------------- ----------------Depth-------------------------------------- Liquid Capacity---------------------------gals. Privy: Distance from nearest well----- -------------------------------------------Distance from nearest building.._______-___-____________-.-._.___-__. ❑ Distance to nearest lot line --------------=-------------- -= Remodeling and/or repairing (describe)--------- -- ----------------------------------------------------------------------------------•---------------------------------------•---------------- s ---------------------------------•--------------------------- •--------------------- 9 --------------------•-----•----••-.--------•-------------•----------•••-----•---------------------------------•----------------------•---•-------------------•-------•----•-----•------------•-•-----------•---------------- -------------•-----------------------------•------•----------- ------------------------------------------•-------------••-------•---------•--------------•---------------------------.---•--------•----------------------- 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. (Signed)--------------zee-.4... .... _ ---(Owner and/or Contractor) rBy:---._----------------- ------------------------------------------------------------------------------------------------------(Title)------------------------ ------------------- -- ---- --------- (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 APPLICATION ACCEPTED BY T ---•------------------------------------------------------------------- DATE---------- -�'�_ _-------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------- •---------- DATE-------------------•---------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------ --------. --------_-------- Alterations and/or recommendations------------------ ------------------------------------------------------------•-•----------------------------•------------------------------------------------ ---------------------------------------------------------------------------•------------------------------------------ ------------------------•----------•-•------•---•---------...........-------•----•............... -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- FINAL I TION BY- \ _ Date-------------r--- — ---------------------- ---------- 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 O. ) .•