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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT_ Permit No. __9_f:_...�.? -------------------------------------------------------- (Complete in Duplicate} This Permit Expires 1�YearR1from Date Issued 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. JOB ADDRESS AND LOCATION., '= ,3y�C /, _ '' /�ZG f'Qp--------- = --------------------------------• ---- Owner's Name--- -t.-------------------------------------------------------- - ---- -- ------ Phone."� 3 81� Add ress_.,:e9.-M. .e.--A ---------------- 'cE" 1'�, cz��.� Sys-c/J_� Phone _ �`3!�`� Contractor s Name-- --------�- ---¢--- - --.._- -�------------- -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑. Trailer Court ® Motel ❑ Other ❑ Number of living units: ---5r.- Number of bedrooms -------- Number of baths __Z_ Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table A-�;_ ft. Character of soil to a depth of? feett: Sand Q Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe p Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes R'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ —AN-o-septic.,tank or,cesspooJ_perrritted.�if.public,seweriis_available:within--200-feet.].—.— Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-.------------------------------------------_-__. . ❑ No. of compartments--------------------------Size--------------------;-----------Liquid depth--------------------------Capacity----------------------• 1 Disposal Field: Distance from nearest well. .r._. Distance,from foundation...Zg'_-___.__Distance to nearest lot line------ J___. -� [� Number of lines------r7/--------------------------Length of each line---,7_;5--.-----------------Width of french-----o751_ __.-------------- Type of filter mate -------Depth of filter material--_/&f,_-_-,-------- otal length-------3104---------------------- U} Saepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__---- --- _`"7❑`"7 El Number of pits.....................Lining material-----------------------Size: Diameter....................... Depth----------_---------------------- Cesspool: Distance from nearest well----_------------Distance from foundation-----------------._ Lining material_.------------.----------._.____-.___ ❑ Size: Diameter---------------____------------Dept h---------------------------m_--------------- ------Liquid Capacity---------------------------.gals. t Privy: Distance from nearest well__-_...______.._.--------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line - -_/--/---_}-'-----------------�----j.-----'---------'-`-�----'-�- 'y�asK I! a --- Remodeling and/or repairingf (describe)- !__?[ _____•_____!_1-1/ �i.___.�. ��ll�. �--/ fir ------- x— ---- --- --------------- -------------- -----__-- - -----t,12T, T ------------- 4'g------A-774jh� ------ _-- --- --- ------------------------------------------------------------------------------------------------ -------- ---------------------------------------------------------------------------------r---------_-------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. !E ��6�E i� c� f //e 6 [Signed] a - --- -- -------------------- ---------------------------- ------------------------ (Owner and/or Contractor) ---�--- -, . �Y -------------- �� (Piot plan, showing site of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ` F R DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------- -DX----- -- - -.- -----_ --�i�Q---------------------------- ----- DATE-------- --- ---------- - ] REVIEWEDBY_ '---------- ----------------------------------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED---------------->-------- --------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:==------------------=---------------------------------•---------------------�;: ----------- -;--------------------------•--------------------- --- --------------------------------- - --------------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------- -- ,- _ FINAL INSPECTIO Date-- ......... 7 �7-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r•.P.0 o. 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