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I/ rUK Urr11-t Uot: G s—------- --------- - l)- X zf � .--- � _._.-_I_<'!�__- APPLICATION FOR SANITATION PERMIT Permit No. � -9-- --------------- 3"3U (Complete in duplicafie) -- ------- ---------------------- This Permit Expires 1 Year From date Issued . Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constru . and install fthe work he ehn d cn ed. Thisa plication is made in compliance with County Ordinance No. 549. PT vy e JOB A©DRESS AND LOCATION_ ---P17 YA,IF f--0-fir f J y e Owner's Name ' ;} Phone Address--------------------------- -•----------------------------- -------------------------------------....__-- Contractor's Name--------- ^� /� ala------ d ----- -•-------------------- -----------------------------------------•---------- Phone.----•-•---••---•-----------------• Installation will serve: Residence ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ [JY'Apartment House Commercial I Number of living units: _/-_ Number of bedrooms _o7_ Number of baths _ Lot size Water Supply.pp y: Publicsystem ❑ Community system ❑ Private ®r�Depth to Water Table 6474. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date___. --------) No U2--"New Construction: Yes 9?'no ❑ FHA/VA: Yes Z+-"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well_dee__Distance from foundation---4o'.�_.__.___.Material_- _��-�r�_______________-_--- � No. of compartments_.-._ ---------Size�� ' � - - - --��-Liquid depth------� -----------Capacity,/- - • � Disposal Field: Distance from nearest well.. -..--Distance from foundation foundation-,1249--------- to nearest to line--=_ �4 Number of lines-----�.. --- ---_-- _-z Length of each line_-70-_-- -----�- Width of trench------- -------------------- Type of filter material Gf�►_-Depth of filter maferial_.� - ---- Total length__�� ------------------------ -- ------------- Seepage Pit: Distance to nearest well__/_,Za-------Distance from fo ndation- -- ------------Distance to nearest lot line______ .._ Number of pits__X,__.,---------Lining material_ d. ._.Size: Diameter_-NZf`i_- --Depth_a��a Cesspool: Distance from nearest well----------_______Distance from foundation------------._------Lining material__"___...___----_-----r'---_ ❑ Size: Diameter___-._.____ ---------------Depth--------------------------- ------ --------------- Liquid Capacity..----------•-:-----....--gals. Privy: Distance from nearest well_________________ ___-.___._______.__________..Distance from nearest building..________._____________-__ ---------- ❑ Distance to nearest lot.line----------------------------------------- Remodeling and/or repairing [describe--------------' ... !-------- -- ... k ---------------------------------------------------------------------------------•-•-----------•---------------------------------•--------------------------------------------------------------- - ------------- I hereby certify that I have prepared this application and that the*work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. L� (Signed) -- -- ----- ---- - --- ---------- ------ r Contractor) -- ---- ----- ---------- By:------------------ --- ------- -------------------------------------- --- ------ -, 5 - title._ (Plot plan, showing size of lot, location of system in r ion to wells buildings, etc., can be placed on reverse side). q ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --- ------------- Sy SAS WED I BUILDINGPERMIT ISSUED ----- ----------------------------------------------- DATE-------- --------------------------------------------------- - ---------•- - - ------------------------------------- DATE---------- Alterations and/or recommendations:_..___.. �'� _ca.✓ , r---------------- ------•------------------ --------------------------- ------------------------------ ------------------------ -------------------------------------------------------------------------------------- --------------------------------- ----------------------------------- ------------------------------- ------------------------------------------------------ --------------------------• ------------------------------------- ---------------------- --------------------------------•-----.-----------------------------------------..__.---_---------•-------- ---------------------------_--------------------- -------------------- ° ___.___- FINAL INSPECTION BY:..... Date------...... %CO.S --------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1841 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California • F.P.0 O. ; � s � � i