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�l APPLICATION FOR SANITATIONERMIT �/,,�,-Permit No. Z „ }( (Complete in Duplicate) /a �5_7yl)ate Issued Appliceion 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. 9. i ° JOB ADDRESS AND LOCATI N_' -0 Owner's -,/--------------- Name----- � t--_-- , -----------------------—� - ---- --. - - - Pone. - j Address -- --- ' — . Pho. Contractor's Name---- - - r ' --- ----" -••---•- Installation will serve: Residence ❑ Apartment House`❑ Commercial ❑ Trailer Court Motel Q Other ElNumber of living units, _ ______ Number of bedrooms -------- Number of baths -------- Lot size _ r Water Supply: Public system-E] Community system-❑ Private }--$epfh to Water Table S--- ft: Character of soll to a depth of.3 feet: 3Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ardpan ❑ L�� Previous Application Made:, Yes-El No �1ew Construction: Yes ❑ No ej -- TYKE OF INSTALLATION AND SPECIFICATIONS: i (No septicAfank or cesspool.permitted if public sewer is available within 206 feet.) f Septic Tan : Distance from nearest well________________Distance from foundation___----- ._____`____Material___;_ _---_- ------- ) No.of compartments---------------------------Size -----------------------Liquid depth--------- ---- ---- Capacity---... ....--------- 0 Disposal Field: � Distance from nearest well-----------,------Distance from foundation-------________'__-_-Distance to nearest lot line._______________- Number`of lines-____t____.___-_ - F ----------------Length of each line_----- - W�dth of fren'ch-------------------------of filter material ------ -Depth of al. , ,. ... . • ---- -----Total length__ Seepage Pit: Distance.to nearest well_i�[�---_----Dista om fo ndat on___ D' fiance to.nsarest lot line_ •• - Number of pits------- ------------Lining mater" ---- ------ ---S' e: Diameter ,� ` n ---------------------- Distance - Cesspool: from.nearest well-_._-______-____Dista e from dation_____________ ____ Lining material------..____._______-__-_- ❑ Sizer Diameter--------------=------------------ ----Depth--------------------------------------------------- ------------------ - , ?-Liquid Capacity --------- ------!--gals. Privy: Distance from neatest well _ -_ - ` { - -----------------------=--Distance from nearest building • � � Distance to nearest lot-line._----_-- '_:: : - _ _ . ----------------------------- Remodeling 'and/or repairing (describe)___________________________ ____ ---------------------------••---- _---- --- :- : ---------------- --- -- ----------- ---------------------- •------ .' ----------------------------------- --------- --------------------..,--------------------------------------------------------------- -------------- hereby certify than I have prepared this;application and that the work will,be done in accordance with San Joaquin County ordinances, S ate laws;and rules and 'regulation of fhe San Joaquin Local Health District. Si ned ( J ) We;& '� , ----------------------- } Y: --------�rContractor}B :----- sha -------------------------------------------------- -------------- ---- ----------- {Title(Plot planowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r i t FOR DEPARTMENT USE ONLY .'APPLICATION ACCEPTED BY_ .Yn�-k ~' } ----------------=---------------------- -- == DATE- ----------- --------------- BY = - ''-"' '------------------------- ----- -----------------•-------- ----•- - DATE .r r- { BUILDING PERMIT ISSUED-------------- i S' e. •-------------------- DATE--------- Lf - I - , ,_;N--•-------------------•---------------- V ` / - - ;.� - - est i Alterations and/or,recommen etions � - ------------------------ -------------------•---------- y I F -- - _ ---------- -----••----•--_-- ' --- - y i � - -- a --, --- - ` - --------------------------f _ ---- FINAL INSPECTION BY: of:---- �" V9 6.,_.,:._1 �' Date_ 3 ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised W-2100