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FOR UFFICE USE: ----- ------------------------ -------------------------- -------- ------------------------------------------------ -------------------------________ _____________________________-_.___..-__-____. APPLICATION FOR SANITATION PERMIT Permit No. ........................ ---------------------------------------------- (Complete in Duplicate) -------------------- --- This Permit Expires 9 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 A OCATN---_-- ��C�J=-•-•----- F �• ---•------.�t2 ` - �;... OwnersName.--•--- = = --------------- =- -------- - --- ------------------------------------- Phone--- -------- ........... Address --------------- -- --- c... �- Contractor's Name 'oc'=krc% '1 .. ..... -------------- Ph'o ..�1� -Z`• a'It installation will serve: Residence ; Apartment House ❑ Commercial El Trailer Court ❑ Motel [:1 Other ❑ Number of living units: . Number of bedrooms _3__ Number of baths ---l-__ Lot size . .4V--- _ _1_ _____________________ Water Supply: Public system Communitysystem 4 Private E] Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand�CGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,doteYl-._--�-_ .) No El New Construction: Yes ❑ No E] FHA/VA-. Yes E] No El , TYPE OF INSTALLATION AND SPECIFICATIONS: (No s1.eptic tank or cesspool permitted if ublic sewer 's available within 200 feet.) Septic Tank: Distance from nearest we ____Dis ante from foundation.--x0A-Materiai----- /� _ No. of compartments------ -------------SSi�ize---�l 4.X-1V----Liquid depth__.-`-------------------Capacity...^b Disposal Field: Distance from nearest we l __ ______%5 istance from foundatio -- Distance to nearest lot e__r--------------- t __.._.__ _. Number of lines_..-_:_: : _ __ _ _-_Length,of each line____ 4*Width of trench__Br --- ----------IM"_34, YP p Type of filter materyal__ , _--�__De th of filter material___f_ _ __ .Total length______ Seepage Pit: Distance to nearest'well_.__-_ _ Distance from foundation___________________.Distance to nearest lot line___________--_-.- k Cesspool: Distance from nee e-------------Lining.; material---------------------- Size: Diameter-----.---------.-------.Depth---------_------------------•--- Num er of pits__-_-. __ t'well____.•_____ ____Distance from foundation------------- -----Lining material----------_------------..._-____.____. y. Depth_ Liquid Capacity ------------------•--•-gals. --_________Distance from tearest building Priv Distance from r nearest well------------------------------- --- g___-----------------__-- ❑ Distance to nearest.lot line-------------------------------- A ; Remodeling and/or re airing (descrif5e) -----ate CAT.fdlE�_.......... --- ------•e- -----•- -•- . Z'440,111=- ----------------------------- . ." t_ ---- � YAAAAh... --�/IAU-----4-i-v ------------------------- r -- �:� - , M -------- ---- --- `. r r c - I hereby cerfi eW.p€epared�thts=app�t ation and lta S.W.ar�C ri ae ne in accordance with San Joaquin County ordinances, S la and rule d re ations of the San Joaquin Local Health District. (Signed)-.-• - ------ --- ------- ----- ------ =C' --------------------------------------------------------------------------------------------------(Owner and/or Contractor) BY: - ---------------------------------------------- ------------- ----------------------------------------------(Title)-------------------------------- ----•--------- ------ -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,'can beplaced on reverse side)."4' " F FOR DEPARTMENT USE ONLY - qr APPLICATION ACCEPTED SY [ i ------------------------- ----------------------------:------------ DATE....... REVIEWED BY = --------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------- ------------- DATE------------------------------------ Alterations and/or recommendations:------------------ ------- ----------------- ---------- --------------------------I---------- ----------------------------=----------------- ------------ ----- - --•-------------------------------------•-------------------------- . -----•---------------------------- ---- --- --------- -- ------------------------•-----------------•---------------------------------•- ------------- -------------- - ------------------------------ ----------------------------------------------------------- 9.-4 FINAL INSPECT( .. w.. !------------ Date-------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycam are Street 245 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVIVED B-89 F.F.CD.SM 6-6C