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I-UK k0l1-ICL--U5E: — r ---------------------------------- ------------ ' ------------------------------ -- APPLICATION FOR SANITATION PERMIT Permit No. .9A-e_ ,! ------------------------------------------- ----------- - (Complete in-Duplicate) ----------------------------------- ----------- --- i This Permit Expires l Year From Date Issued Date issued Z.O�-(SO--0] Application is h"ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in coTnplipvnce with County Ordinance No. 549. �- ANp JOB ADDRESS' LO AF ATIQUrS ------------'------- ---- t�r------AVs--n-a---.--.-AI?--- Owner's Name-------------- JOHN ----.--• �` Phone --•-------------------------------- Address - Contractor's Name_ -112-C 9� , -.-0Ql.%It4(rcM_--- - P.T�- ------ ------------------- - - .. --•-------•----- Phone---- -------------•--- Installation will serve: Residence � Aprartment- 'House'❑-Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-[ Number of bedroom _Y--- Number of baths _� Lot size _--2_20_.----Y4(7 l_`-----------------•--- Water Supply: Public system ❑ Community system E] Private Er-Depth to Water Table -Io_ ft. Character of soil to a depth of 3 fel.f: Sand Gravbl-'.E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No`�lNew Construction: Yes ®�lo ❑ FHA/VA: Yes P9--No ❑ I TYPE OF INSTALLATION AND SPsECIFICATIONS: -„^(No`'3epfie-tank-o-r-cesspool-permitfed-if-public=sewervis=available=within-200_feet) (� _.-.- Septic Tank: Distance from nearest well----S -_Distance from foundation-----/Q_-------Materlal_CQN!Z E_T No. of compart encs_ .—_ ---Size..5---Qfn Liquid depth-. Capacity.j J. Disposal Field: Distance from nearest well---S .-Distance from foundation---10----------Distance to nearest lot� line----- -- Number of lines -..-_ _ Leng ,�(}th of each i line dth of french------- 1 Type of filter material-_R6.:C14_.__Depth of-filter material----- ------Total length-----2. ------------------ Seepage Pit: Distance to nearest well--------N---------- Distance from faundation__._____ �.-..Distance toynearest lot line----------------- ❑ Number of pits-- ---------+-- _ _--Lining Distance from foundation material ce Di 'L ate - --------- ----Depth-------------------------------- Cesspool: Distance from nearest well_�r” - Lining material------------------------------------- y>« ❑ Size: Diameter------------- =' Depth t� Liquid Ca acit +tee+r- . ----- r. -,. p y----------------------------gals. Privy: "„Di'sfance from nearest well--.------ °�tk- ' ------ --------------Distance from:,nearest:build•:ng_----_--_.--------- �iwi e------ ..y.�..�.�. ��... --------------- Distance to nearest lot lin = ------- ---- ------ - , Remodelingit 0-T-, and/or repairing describe :--x_- i / P g 1 �.- t . ----------•------- •---:�,_. -------- !---------•----jW--- � �t t -- --------- -- ---- ------ ------------------------- ----•------------•---------••------------- ••- --=---•--:;:-------------- t if r - ----------------------------- --------------------------------------•----------------------------- ------- ------ 1 Hereby certify that I have",piepared,t.his application and that the work will be dontfln accordance with San Joaquin County ordinances, State laws, and rules and regula.fions of the San Joaquin Local Health District. - ------------------------------------------------ ---•---------------- -(Owner and/or Contractor) (Signe ---rf� )d] tf t - -------------- ------- --- --------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can:be placed on reverse side). i«ri FOR DEPARTMENT USE ONLY ^i~ APPLICATION ACCEPTED BY.....Ti- ..0E•---------------I---------------------------------------------------------- DATE------ 1 REVIEWEDBY-------------------------------------------- -------------------------------------------------------------------------- DATE------ ----------- BUILDING PERMIT ISSUED--------------------------------------------------------------- D- ATE-----a- -_---------- - .--- -------------------------- ------ --- ------------------- . --------------------------------------------------------------- t - r_ ---------------- ------ �- - -------------•---------------------------- ------ --- - - ------------- - ------------------- ------------ -- ----- ------ . ---------------------------------•--- E FINAL INSPECTION BY:-- -- --- ----- Date- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noselton Ave. 300 West Oak Street 124 Sycamore street I 205 West 91h Street Stockton,California Lodi, California `" ' d Manteca,California Tracy,California f F.P.Cq. f 't >I