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FORFl USE: �� - Cu------A.. '�l.. ------------ ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ----------------------------- ------------ (Complete in Duplicate) Date Issued .....,./..��_ ------. This Permit Expires 1 Year From 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 County Ordinance No. 5 9. Z– p ( ` i' �* JOB ADDRESS AN LOCATION- �Ie ---- ...... .. -. Q�------•-----••-- Owner's Name •---OV16----------Z-� --1A, Phone 1 Address-------------------------------- --•-4`4-------SOoy_//..-_........... a _�ll✓ / ` - ------ --------------- .C.6 ---- - Contractor's Name----------P. -- .wy------- r K l ¢� l i Phone -s c �•--• I Installation will serve: ' Residence ❑ Apartment House ❑ Commercial { Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms .------- Number of baths ------- Lot size .__940-C--_1�---------------•-------------- Water Supply: Public system $ Community system ❑ Private El—Depth to Water Table�a_Vft. Character of soil to a depth of 3 feet: San,,,,//d (IGravelw❑-.` Sandy Loam El Clay Loam [3 Clay E] Adobe 9 Hardpan ❑ Previous Application Made: [lf yes,date__�Y.0{..-..°_ 1 No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE_ OF INSTALLATION AND SPECIFICATIONS:.k ` t (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) Septic Tank: Distance from nearest well__A/t)Y4-_Distance ffrom foundation.. .__ Material---- 44 - r• oZ - Material - No, of compartments-*yWo.-..-.--..Sized_.-. +3 -. _Liquid depth.. .....?�.D.....-Capacityl. ..�©. . �. ,p 1 , Disposal Field: Distance from nearest well-AIPP '._.Distance from foundati�_..-.._:..:Distance to nearest lot line..fe......... Number,of lines----4"'_—-----_---_Length of each line----- ..0 fir----------- trench--e.,04-1 material length_......�PQ_-._. --------------------- a Seepage Pit: Distance to nearest well - _ _ ��-__D'atan+ce om f .ands#ion.�.P_.___.._._ ist�ance to nearest to line.... .. ........ . • Number of,pits- Lining-�� .;Lining,material__ Q ....Size: Diameter..% .............Depth.. ' . ..,_-....... Cesspool: Distance from.nearest well__-_-...'.....c..Distance from foundat•son--------------------Lining material--__.-...-_------._..---.-..---------. ` ❑ Size: Diameter'__- ----- ' '` =--`.----Depth_ -----------------------Liquid Capacity-...---------:--------------gals. ` Distance from nearest building Pri y: Distance from."nearest well a.R '�`; _ _ 9 ❑ Distance to nearest lot;line---- J ------ ---- --- Remodeling and or re�aiirin (�desc�ribelr° ; - --- ---- - ----- -- -- -• ---------- _ -- - - ----- ----------------------------------------------------- —'a t - ,.' .. 3 hereby certify Hist.)•have prepared this applicati nFand that they A will lee done"' accordance with San Joaquin County ordinances, Sta a s, artd`,rules and i Julafions.of fh -San` aquin L- Al 'H Ith Distr' (Signed)------- ---------------- ---------- --- -- -- - - - ----- (Owner and/or Contractor) buildings, etc., can b (Title) (Plot plan, showing size of o+, location (if syste relation to wells, a placed on reverse side). FOR-DEPARTMENT USE.—ONLYff APPLICATION ACCEPTED BY---- •----------------------------- '-------------- DATE-------- ! ------------------ REVIEWEDBY--------------------------------------------- --------------------------------------------- DATE------------------------------------------------------- --- BUILDINGPERMIT ISSUED----------------------------------------------- -------------– DATE------- --------------------------------------------•-------- Alterations and/or recommendations------- ---------- ------ --------- ---------------------------------------••------------•--•••------- ----- ----_----••---------------� ------- -- - ------------- -------------------------------------------•-- - --------- -- -- �-� . ��' ------ ------- ------------------------------------- --- ---- ---------- ------------- ------------------------------- --------------------- INSPECTIONBY:-----,'- ----------- ----- -- --- --- --------------------- Date-----------u�---- --- --- ------ --------------•-------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVIBED 8-59 F.P.CC.ZM 6.50