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FOR OFFICE USE: !� . ....... _-___-. APPLICATION FOR SANITATION PERMIT Permit No. Lff>9-U ---------------- --------------------------- (Complete i4_ Duplicate) Date Issued ---------------------------_...___._..._.__.___-.-- -- This Permit Expires i Year From 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. i JOB ADDRESS AND LOCATION------uaz? 9. (&& I'{ Owner's Name-" ame - Phone - GE�. ---- / Address--------------"_10- -cam,,��!+._- -------------------------•------------•--•-•----------------------------------------•--------------------------•-•-•----- Contractor's Name _ --------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Ile Number of living units: A Number of bedrooms _e- _ Number of baths Lot size - �a _______________________________ Water Supply: Public system Community system ElPrivate ❑ Depth to Water Table Aa ft. J Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E--nardpan ❑ Previous Application Made: (If yes,date--------------------) No [p/ New Construction: Yes ❑ No k2o-"FHA/VA': Yes ❑ No R;— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) t Septic Tan Distance from nearest well_________________Distance from foundation__.___-___-_-_--._.Material------------------.------------------------------ "E No. of compartments--------------------------Size-----••-------------------------Liquid depth---------------- ----Capacity--•-------------------- / -- Disposal F' I4: Distance from nearest well----.=J.._Distance from foundation_..�G.�_ ____.Distance to nearest lot line___.._____ rt � /i'l� Number of lines--------- ._ Length of each line_._.r2 's:�� Width of trench_. -________________________ Q Type of filter material Depth of filter material_____� ___.__._Total length--- _t ____---------- ---------- - / / Seepage Pit: Distance to nearest well.......'------------Distance from fo�ndaton__� ___ Distance to nearest t line- U__ Number of pits--- J/-_----__._Lining material--�_.Size: Diameter_! _...__-Depth- _ `------------------- Cesspool: _________________Cesspool: material 9� tI 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 _-..------_--___.__.___________.._.._._.Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- d' = "� �y, I '-----------------•-------------------------------------------------------- i ---------------••-------------••---- -•-------------------------- ------------------------------------------•---•--•---------------------------------------------------------------------------------------------------- -----------------------------------------------------------------==---------------------------------------•--- -------------------------- ---------------------------------------- --- ---------------------------------------------------------------------------------------------------------- ------ ----------------- --------------------------- 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, l (Signed) --------- ---- --------------- (mor Contractor) B : ---- -- ------------{Title . --- Y ) ,e � �� (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). r + - d FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY.-•------- - - ---------------------------------- . -----------y-------- DATE---------�� ! Cfi REVIEWEDBY-------------------------- ------ ------ --------------------------------- ------ DATE---------------------------------------------------------- 'E BUILDING PERMIT ISSUED------------------------------------------------------------•-_-------------------------•----------._ DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------ ------------------------------------------------------ ---------------------------------------------------- --------------------------------- --•--- -----------------------------------•- -------------------------------------------------------------------------------------------- ------------------•-------------------------------------------------------------------------- ! ---------- ------------------------- ----------- ------------------------------------------------------------ ---------------------------------------•-'----------------- ------------------------------------------ ----------------------------------------------------- --------------------------------------- ------- ------------------------------------------------------------------------- ------ ------------------------------------ - ------- ------------------------ ----- ---------------------------------------------- FINAL INSPECTION BY:-- - - - - G ` Date------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street !i Lodi,California Mantecar California Trac California Stockton,California Y, I'