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FOR OFFICE USE: - - ------------------ - - -__ . APPLICATION FOR SANITATION PERMIT Permit No. � ..... .. 9 - (Complefe•in Duplicate) -<� - -.---------- -- This Permit Expires 1 Year From Date Issued Date Issued �w --------------- Application is hereby made to the San Joaquin Locaf Health District for a permit to construct and install the work herein scribed. This application is made in compliance with County Ordinance No. 549. c � JOB ADDRESS AND LOCATION.--I. . Owner's Name------------- - / - JlL.-----� -4j4-�$� - - J�-------- - - ----------------------------- - -+-- --- - -- - - - Phone------------------------------------ Address------------ ------ --------------------- Address-----------• - , r�� i ✓ f� � Contractor's Name-- /�LL L -/ L�- G. -------------- ---- --- Phone------ ------------ --- ---- --- Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_I._ Number of bedrooms S__ Number of baths_A_ Lot size -.C-..!/C=!`#1 ------- ------------------------ Water Supply: Public system ❑ Community system ❑ Private k-1Depth to Water Table 96��rt 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 Zr New Construction: Yes Z?Ilgc ❑ FHA/VA: Yes es 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__/QV_Distance from . .. r-Size- --k_41-,.... 1r Liquid dept'_ No. of compartments..._.. �f , Disposal Field: Distance from nearest well 1 ,�-0 -....Distance to nearest lot line_-� p _�_,�_-_.-Distance from foundation.._ -.-.-._- Number of lines ... _-. Length of each line__ _(FQ_. --------------Width of trench-A..:.-- -------- _____________ Type os filter material_ / W1_ ___Depth of filter material._ ._--.-__--Total length__r Q__-_---.._- Seepage Pit: Distance to nearest well_____ __Distance from foundation--------------------Distance to nearest lot line ---------------- El Number of pts--. ----------.. - Lining material------ - --- -------- Size: Diameter__- --------------- Depth----- _--- ---------------...__. Cesspool: Distance from nearest well _--------------Distance from foundation. _Lining material-_____ __-_---.--_------..__-____ ❑ 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):_ -�l ----------------- ------ ------------ ---- --- ----------------- - --------------------------- ------ --- ... -- . ---- -------------------------- - - ------ ----------- -- ---- ------ -------- - -------- ...... - ------ ----- ------------- - ------ -- ------- ------------ ---------- ------------------ --- --------------------------------------------------------- - --- ------------ -- , - ------------ ------------------------------------------ --------------------------------------------- ----------------------- ----------------- - -- - ------- ------------ 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) - - - -.{ rr r Contractor] sY - - -l�'�- - ------ - -(Title).... -� - ...-... (Plot ....-------...- plan, showing size of lot, location of system i afion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_� ': .= + DATE-- REVIEWED ATE REVIEWED BY---- ---- -------------- ------- - ------ - ---------------L- -- -- - ---- ----- ---- . ----------- - ----- DATE-- - -- --- �---------- ---------- -- - BUILDING PERMIT ISSUES}-------- - ---------_- - - - - ------------------- -------- ------------- - ........... DATE----. ---- ------ Alterations and/or recommendations---------- --- - - - ..--------- - - - - ---------- FINAL INSPECTION BY:_...�'/ `:�;/T.:Y•-- t� - Date_ ' f_ f 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 E.H. 9 2M 1-67 Vanguard Press