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FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT Permit No. 9_111i..._ -a <br />............ ........ ......... <br />........... ....................................... (Complete in Duplicate) Date Issued ;1..r:7e— <br />......................._.__...._........_.. This Permit Expires I Year From Date Issued <br />application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br />This application is made in, compliance with County Ordinance No. 549. 0 20 —&-5' <br />JO <br />ADDRESS AND LOCATION ---- - ----- . ................... <br />Owner's --- -------------- ----- - — ------------------------------------------ Phone .................................... <br />Address ....................... /..................... ...... <br />.0 a . 14 * ---- r - --;q ­ ----------- 41-- -------------- * ------- ­ --------------------------------- <br />Contractor's Name ................ 0, - � .. �� _ -. 0 6 �- --- ----- ---- *k-^- — -- - -- `•r-•----_----_---........ Phone.----.............................. <br />Installation will serve. Residence [] Apartment House 0 Commercial (:] Trailer Court 0 Motel 0 Other <br />Number of living units: -- — --- Number of bedrooms -------Number of. baths ...�t size ............ --------------------------_ <br />Water Supply: Public system El Community system [3 Private Depth to Water Table -------- ft. <br />Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam R__*1C'Iay Loam 0 Clay (I Adobe C] Hardpan E] <br />Previous Application Made: (if yes, date .............. ----- I No E] New Construction: Yes [] No [:) FHA/VA. Yes [] No [:1 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />f -4-1- <br />------------ ----------------------- - <br />Septic,Tank: Distance from nearest well... s!� ...... Distance from foundation .... 10 .......... Material.... 4ntav <br />ET No. of compartments ........ Ai ............. Liquid depth --------- 4,V ..... ------- capacity..V.a9% <br />Dispose Field: Distance from nearest well... .!!;e "..- D isiance from foundation ---- Distance to nearest lot lineV.V <br />Number of lines ......... .... ��­­ .... <br />....... Length of each line ..... jgg� ..------------------ Width of trench ---- !:�7_1 ................... <br />Type of filter material ......... i .... I ------ _._Depth of filter maferi,I_.,..J.Jr.......... Total length..... / k ---- <br />----- <br />Seepage Pit: Distance to nearest well _------------ ------- Distance from foundation_....... ...... _Distance to nearest lot line ----------------- <br />El Number of pits..... -- ..__.......-Lining material ...... ................ Size: Diameter .................. _-, Depth ---- ............................ <br />Cesspool: Distance from nearest well .................Distance from foundation .......... ......... Lining material............._...._____....._.___._._ <br />0 Size: Diameter ..........................------.Depth..................................................... Liquid Capacity ................ __ ...... -gals. <br />Privy: Distance from nearest well .................................................Distance from nearest building ................ _ ............. --------- <br />171 Distance to nearest lot line- .................. ................. . .................................. -------- -------- ------••------ _ -_----_--- -------- <br />Remodeling aod,e, epeip;m4y (describe]: ...... _.._ -------- --------- ...................................... 1 -----_----------------- -------------------------------- ------------- <br />------------------------------------------- I ........................................................................ I—' ...... .......... ....... ­.­ ................... ­ ...................................... - <br />I-- ............................ ...... ........................................•---•----•-•-•----.........-----.......................... .......... - --------------------------------------------------------- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, S, laws, and rules and regulations of the San Joaquin'Local Health District. <br />(Signed)----- ------- ............. ................. -•----...v ­--fticaer and/or Contractor) <br />-------------- ----------------- ........ <br />By: ..... .............. L .......................... <br />�_sem in relation to wells, buildings, etc., can be placed on reverse side). <br />(Plot plan, showing size of lot, location of <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY. ---------- ................................... ------ ........... <br />REVIEWEDBY----------------- --.............. ---------------------------------------- .................................... DATE-------------------•-- ............................. <br />BUILDING PERMIT ISSUED ........... ............. __ ................. ............... . ...................................... DATE ...... ...................................................... <br />Alterations and/or recommendations:........--------- ------------- ......................................... ........................ ........................................................ __ <br />FINAL INSPECTION BY:._.1_114_f:-,!1_10!?_FE_;�'t'=r'y-!.:--------------- - - ------ ---- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 S. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />