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F09 OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .: 3 r ------- - ------------------------------------ ---------- (Complete-in Duplicate) Date Issued ... .....--------- ----- -------------------.---.__.. _-- This Permit Expires 1 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 d'in}ante No. 549. JOB ADDRESS AND LOCATIONN---------- (E�----.---DL/-,_ �.f7-CSP/ ----` �-------- �� 44Z�-------- - AA Owner's Name-------- .d' _----� :Jn�a�.E � fl .> L'3.A' ' `--------------------------- ��V--- Phone---------- Address------C -------------------------------------- --- ------------------ •------------ J �/ - ---- ---- --- Phone--- / ` �/ Contractor's Name--.��r7-C�''...- ---�t-L�Q�� =�G- ��--- - - 4F�'C1"3_9.TJ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: j---- N ber of bedrooms.- Number of baths ---/_ Lot size ..... ./-Jc Z- �----------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [8---Hardpan ❑ i 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.) tic a ��"-� Distance from nearest well_.-----------....Distance from foundation-----------------._Materlal ........ ------------------ ---#__._.___-.__.. J Flo. of compartments--------------- ,r --Size-------------------- -----------Liquid depth--------- - ----- ------- Capacity...-'.. - •-----.f--- \ �a i Id: Distance from nearest well-NME..Distance from foundation.jo2_1.._..Distance to nearest lot line.-...-.... Number of lines ..1__._. .- --------Length of each line.- ._ __Q...�-------------Width of french--.....z4e.`._` ----_.... �c� -- ----- Type of filter materiat.� p �� g ... ._ _ Depth of filter mate al.....� __ Total len th____-_................ .. �----...- Seepage Pit: Distance to nearest well___;.-----------------Distance from foundation------------------- Distance to nearest lot line.-.--.---..-.__. ❑ Number of pits -- ------------ ---Lining material----------s........... Size: Diameter-----------------------Depth------------------------ - -- __ Cesspool: Distance from nearest well ................Distance fromfoundation----------------_ ..Lining material.....-.- _-----.-.--....._-------. ❑ F Size: Diameter- -- ------------' --- -----------.Depth_----`--..._.-.4-----------------------------------Liquid Capacity- - -----------------------gals. Privy: Distance from nearest well------------------ --------------- ----- ------Distance from nearest building-------.---------- *'-..------__-_--. ❑ Distance to nearest lot line ----------------------------------------- ----------- ------------------------------- ---------------------------------------------------- - Remodeling and/or repairing (describe):--- - - - -- -•--- --•-- -- --- ------•-------------------- Ell! ---------------- ---------------••-----•------------------------------------------------ - ----------- -------------------- ----------------------------------------------------- --- -------------••-------------------- -------------- --- ----------------------------------------------------------------------- ------ ------------------- ------------ I hereby certify that I have prepared this application and that the work will b done in accordance with San Joaquin County ordinances, S to la and rules and regulations of the San Joaguic�oyal He District. (Signed)-_J -- 4It 1-L . . '� 1. - r Contractor] 7 By:------------------ ----- --------------- --------- ........ . -------- ,----(Title)---------- ------ -----_--------------- ----------.....-------- (Plot plan, showing size of lot, location of system in relati to wells, buildings tc., can be placed on reverse side). /', FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY [. -- - -- -------------------------------------- DATE. �� 6l - - REVIEWEDBY---------------------------------------- ----------------------------------- ----------------------------------------------- DATE------ ----------------------------------------------------- PERMIT ISSUED - --- DATE i r ------- ------- ---------- Alterations a /or recommendations:--------;7.? �-----�, A---------- at � c'""�� --•--jx--�X-1jce------------------------------ ----------I------------------------------------- -•----------------------------•------------------• ---------------------------------------------------------------------------- -------------- --- ---_------------------- ---------- ------------------------- .. --_- -•----------------------- --- -- .................. ----------------Z------- -------------- .......... - - ----- ----- - ---------------- ----- - ----------- FINAL INSPECTION BY:..---�--- --------------__------ ..... Date---------------------- ----67--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press