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R OFFICE USE: �. ILI G I _7/-Ll�- �-------------------------40------ APPLICATION FOR SANITATION PERMIT Permit No./9 --�. (Complete in Duplicate) _ _ ___ I--------------------------------- This Permit Expires I Year From Date Issued Date Issued j�zl--------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and insFaR the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.----- II�---" . 1 _Q '� --- �9�Sfi Owner's Name------------------------C._6V_R.�.6 ?1 _ Phone Address-------------------------••-----..----qz ------,Cil_.'--------IR-"eK� 4!---------------------------------------------------••------------------------------ ------- A. Contractor's Name---------._..__-----_____.. Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t r Number of living units: _-_""Number of bedrooms ___Number of baths .. ' Lot size d--------------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:.. (If-yes,date- ---------------•-y) No ❑ _-New,Construction;..Yes..—D—.No..❑.. ,.FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation------------------..Material------- -- .._----- ---------------------------- r� � ❑ No. of compartments---------------------- ---Size---------------•------------=---Liquid depth------------- ------------Capacity----------------------- W i Disposa Field: Distance from nearest well----- Distance from foundation_/-!)-----------Distance to nearest lot [ Number of lines_.----- ___________ ____________Length of each line----�,5---------- -- Width of trench_-__ /---'._______--._-.- NNI Type of filter material----�7-�d" --Depth of filter material___/-- �.___---Total length_____ --_-__-____-_----.----._ � s ..:.-.r -- .rt;. '.. (.may Seepa Pit: Distance to nearest well_ --------Distance fr��m foundation--Z -/._--.Distance to nearest lot line_-S-_ ._.. � Number of pits------/-------------Lining material___r,F,,t".-.Size: Diameter �__6_.`_..._......Depth__erc.... ._.----_- Cesspool: Distance from nearest well-----------------Distance from foundation._ ---------------..Lining material---------------------- .-------___. ❑ Size: Diameter----' ------- --------------------- Depth----------------- --- --------- ----------------Liquid Capacity- ----------------------- gals. Privy: Distance from nearest well_________________________________________________Distance from nearest building------_------------------------------------ . k ❑ Distance to nearest lot line------------------- --------------------------------------------------------------- ------- -------------- --------------------------.------ .a Remodelin and/or repairing describe :---------- 77D ��Y 1 ------------------------------------------------------------------------ i; -------' __ --------------------------•-------------------------- -------------------- --------------------------------------------------------k7 = ---------------- -------- • •- ---------------------------------------------------- I "`J ------------------------------------------------------------------------------------------------- --------- I hereby certify that 1 have prepared this application,-and,.that_the,.work.will.be.done in accordance with San Joaquin County ` ordinances, State laws, an4lrtp,and I•regulations ofµahe San Joaquin-Local Health District. } s ------- ------ r or Contractor (signed)---------------------------------/-��--:_ /�-•S_l�. �.. - -.-----'- --- -------------------- ----- --[ / 1 t ;;! -- ------- ----------------------------------(Tit (Title) = [Plot plan, showing size of Ivt, location of syst m to relation to wells, buildings, etc., can be placed on reverse side}. -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-4 w-- ---- ---------Y ------ --------------- DATE---- 4, i REVIEWEDBY----------------------------------- ----- ---------------- -------------------------------------- --------- - DATE - BUILDING PERMIT ISSUED-------------------- ---------------------------------------•------ DATE--- • -------------.--------- -------- ------------------ ' ; ,..---- j--------------- --------------- Alterations and/or recommendations:----�Pr- ------- ----�� '�--- --------- -------------------------------------------- --- -------- ----------" `------------------------ -------------------------------- ----------------------------- --------- --------------------i------------------------- ------------ - FINAL INSPECTION BY:_1?5< -- Date_...��..16- &� - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.p.c o.