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FOR OFFICE USE: ................ - .-- ---- . APPLICATION FOR SANITATION PERMIT Permit No. _ -•,_--- (Complete in Duplicate` ��,,�,¢9 Date Issued -- .•--•••-. ----•-- --_._--. - --.... ... ;-,This Permit Expires 1 Year From Date Issued n,t/DI/r i- Application is hereby made`;to the San Joaquin Local Health District for a permit to construuctt and install the work herein described. This application is made in compliance-with County Ordinance No. 9. JOB ADDRESS AN / 1 �- . Phone- ...----------------- ---�-•�-- ---- Owner's Name. ...... _ft- ---- .....V- -- . , . ..O -- l ------ ._..Address -.... Phone----------------------------------- Contractor's Name. ------------------- ------------------•._... .._..-------..----_..... r - Installation will serve: l Residence 01j AApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 333,, 3. A: �7-••• Number of living units: _l-.. . Number of bedrooms - .. Number of baths .-1-._ Lot size _..-.-. _ Water Supply: Public,system ❑ Community system ❑ Private-j-�Depth to Water Table l--Qft_ t Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam❑ Clay-•foam ❑ Clay Adobe[� Hardpan E3Previous Application Made: (If yes,date---- -- ------ --I No, *, New Construction: Yeep-j o C] FHA/VA: Yes E] No 0—' TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank'or cesspool permitted if publicrsewer is available within 200 feet.) Septic T Distance from nearest well. .-._`Dlstanc from and on...... ........__._.Ma efral_-__-:_-_. _. No. of compartmenls.. L--.--- Size..--+- -- ------- ------Liquid depth------ - ......_- . -Capacity_ --�� - - --- c� I Disposal Id: Distance from nearest well_ Distance from foundation_lb_. -..-..----Distance to nearest lot line..- -..-- Number of lines..-._:... ��Length oz each line.L.Od =�---LSU .Width of trench..0X=- -. --. Type of filter material-__/ ._QLD .-.-.Depth of filter material/.&..'./.------Dotal length_�.�- .sr.'-.- �- � �_`.- ...:Dista�ze-f foundation�d_--___-_____. t nce to nearest lot line-_`..---__-__ ._ Seepage Pit: Distance to nearest wet / V Number of pits .__.............Lining material--.-� .��.Size: Diameter _ ----... Depth.,x}�.__-._.-- •------- LS Cesspool: Distance from nearest well.................Distance from foundation Lining material.. ....... ........._._..:-.......- _.... Depth. .. .. -------• ------ ------------------Liquid Capacity•-----•--••••-- ---•-•._..gals. N ❑ Size: Diam©ter--- ----- - --------•-.......... P im._Distance..from-nearest-bun s-------------•---_---------- Privy: Distance.from nearest_-well-. -...,,...-._.. ,�..___. - .-�. 9=-- ❑ ............ . .... ...... ......•- -- Distance to nearest lo` ine------------------ ---_..-.._. .... .... . Remodeling and/or repairing (describe):. -...................••__._•-•••.-•- -•-••----•----••- .................. ............................................ ---- ........................ .....-------•._._....................... ...... --------------•--•• .............................................__.. 'f1 ---.... ...__..... - •-- --.-_.....----------•--------------- • --- --- .-•• _.------------•---•• ...... ------ ---- --._._. ...._. --- ------------- ............-....---. ............. 1 Hereby certify that 1 have prepared i appl' afion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re I ions f the Sa oaquin Local Health District. t (Signed. ........ .... ....(Owner and/or Contractor) ,1 d/p or ---- ... ._ ....--.. BY= .. .......... .. ....... ...... ... -----(Title)- - ----- ------------. .. . G {Plot plan, showing size of lot, location of system in re fion to wells,buildings, etc., can be placed,on--rev-erse_si e)-.-_ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. - -- ....................... ...... ,J - (I�DATE.-------- __- - -•----------- .......... .._...--•- DATE----_----------•-------------• --------------------- --- -- - ...._._..-_.-. BUILDING PERMIT ISSUED............................._.............. ...._----------_........................ .............. DATE------------ ------------- ----------- _ Alterations and/or recommendations:................ --•••-.•••••---•-•---•••.•••. ; A ............................................._...... ....................._....------...---•-- f-.-.....a7-.-. .. .T...- _........_............_ FINAL INSPECTION BY:. ... . - �- Date--- ! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Ca8}ornio Lodi,California Manteca,California Tracy,California ES 9 PEVr9Eo 9.59 7K 3-•63 rJ6.120.