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FOR OFFICE USE: ��=�0 --------------- l`------ __..y - a_��-_______• __a_ 1p :_ APALICATION FOR SANITATION PERMIT Permit No. 9 ,71.. ------------ ----------------------_ t� ___ (Complete in Duplicate) Date Issued , �Q-.�S� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit construct and ' stall the w/'t:rk berein described. This application is made in compliance with County O finance No. 549. JOB ADDRESS AND LOCA ION_......./��. ............... _._--_- ------------- Phone._ a Owners Name �.1 - �....�t .rC------------ / ---- . � 112_1 Address........... - T. ........��. �? ' y------ �� Contractor's Name. I_ -°='' -----------------------------•------•-----•--- Phone."I�.k.,> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Memel F] Other ❑ Number of living units: --1-. Number of bedrooms .--t' Number of baths ---�_ Lot size -__.,-/�-fe....................... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 'f.�.✓ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam (Clay ❑ Adobe❑ 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.) Tank: Distance from nearest well_-,�.1�-.-Distance from foundation__-c9Z9.......Material--.--------------------------------------------- Septica a No. of compartments_....... ------------- depth---J.�------------ P Y-- i Disposal -`eld: Distance from nearest well .ti.`��/..._.._Distance from foundation.... ...-.Distance to nearest lot line..Zo. .. Number of lines-- ... .. ...............Length of each line....y0-- .............Width of trench---.�.`�... ...... Type of filter material..`�1 --Depth of filter material--/, ``..____Total length......;'�d. ........................ ; Seepage Pit: Distance to nearest well_1Qr?--.--_..-Distance fr m foundation----W--(_..Distance to nearest lot line.-..��.... ®./� Number of pits---.....-�_......__Lining material..� i!_11�---Size: Diameter._.V�----- Depth------.------- ............. `A Cesspool: Distance from nearest well -..----...------Distance from foundation--------------------Lining material-..............._.•--..--..--.-_.---. ❑ Size: Diameter-------------------- ------Depth.---------------------------------------------------Liquid Capacity---_-•--_----------------gals. 1�; Privy: Distance from nearest well.................................. ..............Distance from nearest building------------------------------------------ ElDistance to nearest lot line----------------------------------------------- -------_------------- -----------------------------_--------•------------- -------------- Remodeling and/or repairing (describe)------------- ..............��,f-a 7 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, anules and regulations of the San Joaquin Local Health District. (Signed) /,✓� - --------�" �-�=---<n- ---------------------------------( r /or Contractor) By:......................,F - ' -----------_-- (Title) (Plot plan, showing size' t - ot, location of sysn relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- ------ DATE............., ------------------------- REVIEWEDBY-------------------------------- -------- --------------------------------------------------------------------------------- DATE......................-...--------•------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- ..................................... DATE...........................---------------- •-----------•- Alterationsand/or recommendations--------------------------- -------------------------------------------------------------------------•--------•-----•---=------••-•---------•------------------- ---------------------------------------------------------------............................................................................................................................................................ -------------•-----•--•-------------------------------------------------------------------------....-------------------------------- ---------------------•-......--•---------••--•-------------........-•---•----•-•----•-- ----------------------- -- -----------------------------------------------------------------.-...----------------------•------------------....-------------------------------------- ---------------------- FINAL INSPECTION BY:------- !/---------------------------------------- Date �� r 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.CC. -'