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APPLICATION FOR SANIT TION PERMIT Permit No. VL9 (Complete in Duplicate) . ---- . " This permit Ex fires i Year From Date Issued Date Issued - s 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 Ordin ce No. 549. JOB ADDRESS ANA LOCATION--------------__---._--- Owner'sName.--_"_- [t-/J'"e, ---------------------- Phone Address % 1 �� ------------------------------------- Contractor's Name-_. a-TC1 fi' one -- - --- Ph Installation will serve: Residence Apartment House ❑ Commercial,.❑Trailer'Court ❑ Motel F1 Other ❑ Number of living units: __. Number of bedrooms __-_._ Lot size "- Gd D �' " Number of baths _ "-__ Water Supply: Public system rCommunity system ❑ Private ❑ Depth to Water Table 6-1- ft. M Character of sail to a depth of 3 feet: Sand ❑ Grave! ❑ Sand Loam [:] Clay Loam ❑ Clay ❑ Adobe ardpan ❑ s Previous Application Made: {If yes,date___________ ________ No New Construction: Yes Jo ❑ FHA/VA: Yes [2--Iqo-❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer, is available within 200 feet.)/ 1 Septic T Distance from nearest weld -____Distance from foundation "1-.-_--�__ _. �} n No, of compartments--- -------Size- --_ Liquid depth-----_T /. �7o ,�-'---�- -- -- - --��------ Capacity---- --------- isposa Field: Distance from neare5f well--___."---_•-t.Distance from foundation--�8-'-___-.-Distance to nearest lot line""S�lr"._- each Number of fi ter materiaL1- _._-.-_I7Epthhoff filter materia " width of trench.._ .-y�/ ------------ Type0 � ------1"---Total length----/ ---------------------------- seep U .a Pit: Distance to nearest well."---..�_�..-__--_Distan from foundation--�_ �f U __.Distance to nearest lot-line"_. - . Number of its----:-- _ '� -=' y �. 'f p ,...._Lining material-' - - Size: Diameter-- - ------ ------De to---�� Cesspool: Distance from nearest well-----------------Distance from foundation_-.- Lining materia!_".."__ ❑ Size: Diameter_ • - Depth '\`= --- ----------------Liquid Capacity----•-----------------------gals. Privy: Distance from nearest well _ ; ___--Distance from nearest building- ------------ ----- 9El -----_: Distance to nearest lot line_ . " RemodeSing and/or repairing={ escrit52} --- -- - ------ ----------------- 1 --- ------------------------- -- ----- ----------- _- -------•----------•-----•-----------"------------------------ -- . ---- .---"------ -_ ------------- ------ ----------------------------------------1i----------- ----------- - ------- ------------------------------------------------------------ _ - - --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a ws, and rules and' ulations of the San.-Joaquin�LocM Health District. (Signed)------------- 4"------ 0"iU ---------------------------- ----------------------------------------- ----------- caner and/or Contractor) By:--- ----------- --------------- - - . ---------------------------- FOR ----------- --- (Title) = - ---------- -- (Plot plan, showing size is -location of system in relation to we s, uildings, etc., can be place on reverse side). t ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------- DATE----- - REVIEWEDBY--------------------------------- ----------- -- - --------------------------------- - ---•-------------------------------------- DATE---------- -•----- ---------- - -----------------........ BUILDING PERMIT ISSUED-------------------�---------------- --------------- • -------- -------=---• ----------------. DATE---------------------- Alterations and/or recomme ations:- - ----------------- ------------------------------ /� -- ----------- d� -ncp t ize. ------------ ` ------ --------------- ' ---------- ----------------------------------------- ------••------- --- ----------------- FINAL INSPECTION BY:------- - ------ -------------- ------------- -------- Date--------.1 =� =� --- - --------- -------------------- ( SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3300 Wesi Oak Street' J 124 sycamoFe Street _ Stockton,California � Lodi,California Manteca,Ca205 West 9th streetlifornia ' Tracy,California