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FOR OFFICE USE: .g/ .......... P ---- ------------- -- - ------------------- ----------- - APPLICATION FOR SANITATION PERMIT Permit No. . ------------------- ----- - ------ ----------- --------- (Complete-in Duplicate) --------------- This Permit Expires 1 Year From Date Issued Date Issued / ....... _E 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 o. 549. JOB ADDRESS vAND � LOCA �1. 'TION--- 9 .__/ 4' fd_ .-.----------------- Owner's Name 1�r` 1' 4g-:•�i ----------------- •-----------••-------- ------ --- ........... ------------------------_ Phone-_-------------------------------- Address------ � -�' Contractor's Name - ��^------------- ------- ------ ------ ----- --------------------------- Phone Installation will serve: Residence W?"-Apartment House ❑ Commercial E❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _4 Number of bedrooms.. --- Number of baths Z-__ Lot sizeWater Supply.Supply: Public system �ommunity system ❑ Private ❑ Depth to Wafer Table 96�0 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9i"Sardpan ❑ Previous Application Made: (If yes,dote............... 1 No [ New Construction: Yes ❑ No F iA/VA: Yes W4---Mo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we ---Distance from foun tion-_- �`�G� ��.-----.Mat � - -- -W --- --------- [ � No. of compartments_.._ .............__Size, _ 6<4-Liquid depth__f� ---- ------..Capacit. - i Disposal Field: Distance from nearest wefi.___ -_----Distance from foundation___.�Q_._.__.Distance to nearest lot`ine_ _...._._ Number of lines 4Z...... _Length of each line_ ., a - �- -- ._. ____ _`?._.._.Width of trench__�r._ Type of filter materia/IC��4'14_Depth of filter material_/ _-.-.-`_Tota! length_--_-_________ ------------ i Seepage Pit: Distance to nearest well_.___-' ----------------- --------- Tr f� fou ation__,� __-----Distance to nearest lot line _eg_'_._._ Number of pits___��__•_____________Lining material___ .-__��i _ Size: Diameter___ Depth-194"------------------ Cesspool: Distance from nearest well -------------___Distance from foundation-----.----------- ..Lining material -.--___.____________-__.__.__-__.._.. ❑ Size: Diameter- -- --------- ----- --------------- Depth------------------------------- - - - -----Liquid Capacity----------------------------gals. Privy. Disfance from nearest well------_----________------ ---------------.------Disfance from nearest building------------------------------------------ El --.__-_-_____._.____-__- .__...__..._.❑ Distance to nearest lot line-------- -------------------- - Remodeling and/or repairing (describe):-------- -------- -- _ __ _ ------ ----------- - -------- ----- ---4----------------- ------------------------------------- -------------------------------------------------------------------------•------------- --------------------------------•-------------------------------------------- ------------------------------ --------------------- - --------------------------------------------------------- --------- ------------------------------------------------------------------------------------------------ ----------------------------- -- --- ----- 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 rul and regulations of he San Joaquin Local Health Disfricf. -Azr- - --- ------ - --------------- -------------------- ------ Contractor) (Signed)------------------------ gr - -- - --- --------- (title} , - -- --------- (Plot plan, showing size of lot, location of system ' afion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_W- -..NYV ----------------------- ----- DATE--- I �6.� REVIEWEDBY------------------------------------- --- --- ---------------------------- ----------------------------------- ------ DATE BUILDING PERMIT ISSUED-------- -- ------------- ------- --r-------r------------- DA-TE------------------ ----- Alterations and/or recommendations: 6 - _ ----•----•--------•--- ---------- ---------------------- ----------------------------- -- ----1 f'`'-t-------- � ----- -------------- .................------------ ------------ ----------- ------------ ----- ---------- --------------- -------------- ------------- - --------------- -r--)----- ----- ---------------- -------------- CW FINAL INSPECTION BY:-,--- . "' `"..°.... -------------------- Date-- 0S��i2l_--- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14ozoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press