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h Permit No. .lQ--•---•• APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ------ A lication is hereby made to the San Joaquin Local Health District ffo9r a permit to construct and install the work herein described. nance Thiisapplication is made in compliance with County Ord �� ---- (7/ ------- . ---------------------•- JOB ADDRESS AND LOCATION_._- _ ! .� - ,-Y Phone-----------------------•----------.. 49+� Owner's Name----------E�-`' -'- - -�L�1✓ - -.r�� : --------------------------- ------- ---- ----- --�;-----�k �1 ------------ r Address-__-..._-..._ Phone Contractor's Name------------- ---- =f✓-r- Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ ' -__- Number of baths _-.�-LOt size ___�-�- ��- ��-� Number of living units: _-- Number of bedrooms 3 `Q ft Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ Na ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Material------------------------___- Septic a Distance from nearest well-----------------Distance from foundation-------------------- Capaci#y__----.-____-___- ___-- No. of compartments---- ------ -- ---Size------------------------•-------Liquid depth-------------------- d: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----_---.---_---_ 3 �Dispo --Width of trench----------------------------------- Number of lines-------------------------------- Length of each lineeria_--.------------------ I _--De th of filter material-----------------------Total length---_----------------------------------- � Type of filter material______________ _ ___ p Distance to nearest well__-. f;_ Distance lbom foundation_-- �1- D s a c to nearest lot lin See j - De th �5-------------------- � Number of pits-------/-----------Lining material-_--- - C .Size: Diameter p Cesspool: Distance from nearest well__-------_----_-Distance from foundation----=-------- --_.Lining materialy----------------- ------ als. De th -- ---------- ---- -- ---- Liquid CapadtY g ❑ Size: Diameter------------------------ ----- p ----------- ---------Distance from nearest buildin - Privy: Distance from nearest well----------------------- - - ------------- ----------------- ------------------------------------•------- ------------------------------ Q ❑ Distance to nearest lot line----------------------- ---- _ Remodeling and repairing (describe):-- ----------------------------- ----------------------- ------ ------_-_-- -------•-------- -- -------- --------- ------I__h ------ cert -.that i have rear ---------------------------------------------------------------------------------------------------------------------------------------------- I her ce y p p ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r S and regulatio o he San Joaquin Local Health District. _- -- -- OContractor]' - -------------- (Signed' ---- Cr --------------------- �-�-� -- - ----- - �tle)------ By ' (Plot plan, showing site of lot, location of system in relation to weAs, buildings, , can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE � 1 ACCEPTEDBY------- -- - ---- --- ------- --------- ------- -------------------------------- APPLICATIONREVIEWEDBY------------------------------------------------------------------------------- -- -------------- -------------------------- DATE----------------------------------------------•------------ BUILDING PERMIT ISSUED-------------s:-------------------- : --------------------------------------------------- A aerations and/or recommenda+ions:--- --- =------------ ------- ------- ----------------------------------- ----------------•--•-•-------•------------•-------------------- ----------- -- - /6 .v-------------- T � •��.--�_xj_s�� s�l-------------�N��r,4tif----- r`'� •O� --• ----------------------------------- -------------- ------------ i ---------------------------------------- --- --------------------- --------------------------- Date . FINAL INSPECTION BY------------------------------ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 30D West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California w Stockton, California Lodi, California Manteca, California y' ES-9-2M - Revised 1.57 F.P.CO-