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FOR OFFICE USE: ' ---7-VVA--L0& -- 7-,f r)-------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------'----------------------------------- (Complete in Duplicate) Date Issued � � -� _-----------------------------.------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with ounty Ordinance No. 549. JOB ADDRESS AND L0CATIOt*.- k4;�tlow-------3- -7'69 ` -- Owner's Name------------(��_' _ .teh��" --- ----- ----------- --- -- Phone_ Address------------- - >�nlw --------------------- --------------- --------------------- --•-----------------------•-----------------•------------------------------------••-----------•--- C9 � Y` ------ Phone..----------------------•--------- Contractor's Name. - -• ----- --- ------- .Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/-- Number of bedrooms A- Number of baths _r_-- Lot size JqW1� -- Water Supply: Public system El Community system E] Private,�bepth to Water Table 6-0 ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑, Clay Loam ®/Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dcite______ No ®--' New Construction: Yes ❑ No Wg`FHA/VA: Yes ❑ No g4--n- 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-----------------Distance from foundation--------------------Material----------------------------------___-___---_-. No. of compartments---- ------Size---------- -------------------•Liquid depth------------------------Capacity----------------------- Disposal R Idr Distance from nearest well _._Distance from foundation-ge�_._____._.Qistance to nearest�t line___ .____ Number of lines---___-�-_ -- Length of each line------ --- -- Width of trenchAs------------------------------ l9r------ �- c/ ,�, of filter material _ _-Length of filter mate ial__ .._____...Total length_._._a --------------------------- Type ' Seepage Pit: Distance to nearest well fre----.-_-Distance fr fou anon-__-��-----.Dista ce to nearest lot I e__�l--- Number of pits-_--Z_.____.....Lining materia!-� __..--Size: Diameter �-._.._..___Dept �[ -- �' - . h . Cesspool: Distance from nearest well------------ ---Distance from foundation-}_-_------_---__.Lining material_--------------------------------- ------_ -- ❑ Size: Diameter---------------------- ---------------Death------------- ---------------------t -------------liquid Capacity ;--*--=------------ gals. Privy: Distance from nearest well------------------ -------------.- -----------.-Distance from nearest building----------------------------------------- { ❑ Distance to nearest lot line..- ------------------------------------------------------------- ------------------- ------------------------- - - --- i F Remodeling and/or repairing (describe)-------------- - --,-----------> t --------------------- ------ - - --------- ------------------------------------- ---------------- Vg I hereby certify that I have prepared this application and that the work will be done in accordan i h San oaquin County rf' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ,�f _Owner and/or Contractor �". --------------(Title}. . (Plot plan, showing size of lot, location of system in rel on to wells,'.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- !`� 1 e -7-`/' --------------- --------------- DATE.--- .7 ` ---------- REVIEWED BY-------------------------------- --- ---------- --------------------------- DATE------------------------------------------------------- ---- ----- -- ----- ---- PERMITISSUED----------------------------------------------------------------%------------------ DATE.. ti Alteratipns and/or recommendations:..__...7--I--l-_}-. _-- --,_.._-__ =e-------------------------------------------------- --------------------------------------------------------------•--------------------- --------------------------------------------- ----------------------------- - ------------------- ------------------ -- ------------------------ -- ------- ------------------- ---------------------•------------------------ --------------------------- FENAL INSPECTION BY:..----�_{� �.'---------------- date_-.--- ---- __-- ---- - ---------------- ------- SAN JOAQUIN LOCAL KEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycarnore Street 205 West 9th Street Stockton,Callfornia"i-+ Lodi,California _ Manteca,California Tracy,California F.P.E;El.