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FOR 95RCE USE: -(.,4. ----------------------- �� � - - � _______________ _. ___ - APPLICATION FOR SANITATION PERMIT Permit No. .........7_____ .. .... M---------- (Complete in Duplicate) -------------------------------.--- This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heali:h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina o. 9. JOB ADDRESS AND LOCATION-- --��-- -14- ZZI------------- --`/..S��S'C�'J ----------------------------------------------------------- Owner's Name-------- i-�•Q -.f7-,�--•---•--------- -- -- ----- �C-r ------- ------------- Phone------------------------------------ Address------_----- Contractor's Name" �Z,l�--�' -- -�-�� - -' ---- - -- --- one..---- installation will serve: Residence ❑ Apartment House ❑ CCommercial Trailer Court Motel ❑ Other Number of living units: _-f Number of bedrooms ___f!_ Number of aths __/_ Lot size ___/____�. __. _. Water Supply: Public system ❑ Community system ❑ Private Rr Depth to Water Table __ of. ' Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam ❑ Clay Loam ❑ Cla ❑ dobe ardpan ❑ 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 pu lic sewer is available within 200 feet.) r Septic Tank: Distance from nearest well ______Distance from fo dation_-__-1®____._.Material_.__ _ _.. _ ---- --------------------- [� No. of compartments__...- Size �f__ .. ZLiquid depth_.-__XZ rf ..Capacity___ Disposal Field: Distance from near st well .._.D. Distance from foundation_ �_-_-_.__Disfance to nearest lot line__16-_____ ®� Number of lines__ _ ength of each line___��_!._.________-Width of trench___ �' l�[_-!�-.--_--_-- Type of filter materi - �epfh of filter material____._.4F_ Total length----------------------- Seepage P' . Distance to neares well__ 4 ....Distance om f undation___ ___ _ _ Disfance to nearest lot line_____ Number of pits..... ------_--------Lining materia l_ �� ln_d_ anon Size: biometer._. ---____ _______------- Cesspool: Distance from nearest well_-._________..__Distance from ___________________ Lining material-____-.__-_________.__.______-_--_-- ❑ Size: Diameter- ------------------------- ---------Depth-------------- ----------- -------------------------Liquid Capacity---------- ----- -------gals. ' Privy: Distance from nearest we]------------- ------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line ----------------------- --------- . �J Remodeling and/or repairing (describe)--------------- ------------------ --- --------- ---- �- ------------------------------------------------------------- - t ------------------------------------ ----------------------------------- — • ------ -- ----------------- Ihereby certify that I prepared this application 4� � e work will b done in accordance with San Joaquin County ordinances, State laws, and s��and regulations of the anLoc I ealt District. 5t ned zany vi,941( 9 } --------• P"iIC 1`aNK !✓FiIICE---- ----- --- -- --- ------------ ------ ntractor)2815 i=.Miner Ave. ---6.3041---- ------------------ (Title)BY:------------------------- t------O._ --- ----- ------ (Plot plan, showing size of lot, location of system in tela • tuildings, c., can be placed on reverse side). FOR DEPARTMENT USE ON APPLICATION ACCEPTED BY ------------------- ---- (DATE---- -- REVIEWEDBY- ---------------------------------- ---------- -------------------------- ---- ----------------------------- ---- -- ------------------------------ - -- DATE---------------- ---- •- ------------------------------ - BUILDING PERMIT ISSUED------------- --------------------------------------------------------------- DATE --- Alterations and/or recommendations: __ - _ ----- -------------- . . ,. _ s_ � . n ---- -------- ----- --- - --------------------------------------------------------- ------ -- ---- ---- --- ---- ----- -------------------- -------- ----------------------------- ------------------------------------ --------------------------------------------------------------------------- ----------------------------------------------- --------------------- i FINAL INSPECTION a :._ --------- - ------ ------ - Date_ -._ � - Y//� t _ 2_� I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.RC O. r