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OROFFICE USE: _ + ---�� '-----L:-1---- --------------------1 3° -------------- ----- - APPLICATION FOR SANITATION PERMIT Permit No. . ?_ _ , �-11-�'I��------- ------------- (Complete in Duplicate) / Z Application - --- ---- --- -------------- - --- This Permit Ex ires I Year From Date Issued Date Issued -----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 Ordinance No. 549. } JOB ADDRESS AND LOT,PO N ----------------�----��--I l 9✓ t 7 A �c -` Owner's s Name ---------•--- Address---------------"A +�, Pone k Contractor's Name------------------- ---- - 1 ------- ---•-------- Phone Installation will serve: Residence t Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---)_._ Number of bedrooms _____Z,Number of baths __1____ Lot size -40------_ _ -- - ---./ Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table _/rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe©hardpan ❑ Previous Application Made: {If yes,date________------------------ .No 9---I�ew Construction: Yes ❑ N6;D---FHA/VA; Yes ❑ N04-- TYPE.OF INSTALLATION AND SPECIFICATIONS- (No PECIFICATIONS(No sepfic tank or cesspool p,rmitted if public sewer is available within 200 feet.)' Septic Tank:. Distance from nearest well___-r------Distance from found ation__,1 J Material C -e '------------ -- No. of compartments--------- ----------Size-------� - -r ---=---Liquid depth--- 7 g Capacity Disposal Field: Distance from nearest well____ . -_Distance from foundafion_--,fit?_�____-Distance to nearest lot li e___ �--___ Number of lines-------- #__ __ t g f __�_�-___.._.Width of trench-cD --_____.�_-�___..__-----Len Length of each line-__-____ __ -------------------------- Type of filter material____ --Depth of filter material--- !.(-__---Total length--------- - -__------_-_------ Seepage Pit: Distance to nearest well____--"`__-._:__Distance fr9m oundation___ L'-- Distance to nearest lot line-S 1 �d ©' Number of pits--- ____________Li _____ning material_ 4.__-____.Size: Diame e-_ /----_---Depth----..--. Cesspool: Distance from nearest well____'___- -- Distance from foundation-__________________Lining material____.-.__--- __-_.------------------ (}� Size: Diameter.. .I- ------------------ Depth------------------------------------ ---------------Liquid Capacity- .---------- -------gals. Privy: Distance from nearest well._.-_' _ ________________________________Distance from nearest building g ----------- r� ❑ Distance to nearest lot line------ - ------------------- Remodeling and/or repairing (describe):------------- _ ------- - ----------------- --------------------------------------------------------------------- ---------- ------------- ----------------------------------------------------------------- -------------------------------------------------------- --------------------------- --------------------------- --------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, State la and rules a.nd-rV ulations-of-fhe-San-Joaquin-Local-•Health-Districf. (Si ned / � ; 9 } t�C ---------------------(Owner and/or Contractor) t Plot Ian, showing size of lo#, atiof of system in relation to wells, buildings, etc., can{bele}faced. BY-------------------------------- ( P. 9 p on reverse side). I FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY- ___.: I ex"--- ------------------ - 3 / --------- DATE- . ... IEWEDBY- ------------ F- ---------------------- --- ------------- BATE BREV UILDING PERMIT ISSUED---------------- ------------ - ---------------- ------- ---- ------ DATE--- --- -------- ------ Alterations and/or recommendations: -� - �- ef -- ---------- t ---------- ---------- ------------------------------------------------------------------------------- 4 ---------------- ---------------- --------------------------- ------------ -------------------- ------------------------------------------------ -------------------- ----------- ------- --------------- ---------------- ---------- --------------- --------------- ------ ------------- - -------------------- ---- ------ R ,. --------- ----------------•----------------------------------------------- ----- FINAL INSPECTION BY:.._---------- .-____-_�-�-. bate --- -- --------------------- -------------------- -------� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave t fa 1 + 360 West Oak Stiee -� ' 124 Sycamore Street 205 West 9th Street Stockton,California ' Lodi, California Manteca,California Tracy,California F.F.0 O.