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----------------- -- ----- APPLICATION FOR SANITATION PERMIT Permit No. �-•-'? 3 ..-�._----- - � -- � -�---- (Complete in Duplicate) - -------- This Permit Expires i Year From Date Issued Date issued �.�-......... Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordi nce No 9. JOB ADDRESS AN LOCATION a IL I Owner's Name__. - - ..e- �. n ---- Phone Address-_--,' --- -- -•-------------•-----• � .1'' ' ----•---------------..... .--- ---- -•-------••- --••---------------------•----------•---------•--•---------------------- Contractor's Name____________ ` 'I� -------------------• -------------------------------------------------------- Phone��.� Y:6/Q ---- nstallatian will serve: Residence 93�Aparfinent House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ 11- ` ' .- __ '" Number of living units: -- ---- Number of bedrooms -.,oz Number of baths ___/_ Lot size ___ ` Water Supply: Publicsystem [l Community system ❑ Private p Depth to Water Table ________ ft. Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ Y ❑ y ❑ Adobe(�I-lardpan ❑ Previous Application Made: Ilf yes,date_________-----------) No El New Construction: Yes ❑ No Q HAMA: Yes ED No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tk nk: Distance from nearest well _Distance from foundation__._.__...__ ----- Material................................................. No. of compartments. ---------Size--------------------- '-----=-_-Liquid depth---_---- •- capacity p tY...................... Ild: Distance from nearest well-----------------Distance from foundation--------------•--_ • Distance to nearest lot line................. Number of lines-----------------------------------Length of each line----_-------------------------Width of trench---_------•--••----•----•-____ Type of filter material-------------------------Depth of filter material----------------------- Total length_.. ................................. Seepage Pit: Distance to nearest welpis+once m f undation__P� r � ��j -----_,Dis arAe to nearest lot line_- ---_---- �� Number of pits____..------- -•-Lining material-.-t�-1;4- ,�,� --- Size: Diameter-.... Depth__.v _. \ Cesspool: Distance from nearest well--------------___Distance from foundation_____-________.____Lining material_.___.-_.._____..______.___.._ ❑ Size: [7iame e '--- "-_-• "� Depth----------------------------------------------------Liquid CapacitY--•-----•----••-------------gals. Privy: Distance from nearest well______ _ Distance from nearest building, ❑ Distance to nearest lot line_________________________ ---•----------- Remodeling and/or repairing (describe):-------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- -------- -----------------------•-•-----•-------- --------•-•-------------------••--------•-----------------•-•--------••----------•--------••-•--------------------••---- I here ertify that i repared this-application and that'the work will be done in accordance with San Joaquin County ordinances t t M and rul s nd regal 'ons Zofha San Joaquin Local Heal+h Dis+vitt. �,(Signed) 4 -------••-------------------------- --- ner and/or Contractor) By:. T. - ---- - (Title)----•-- {Plot plan, showing size of lot, locatio of system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... ..--_-_ ,�_ .- -----------------••---•-------- DATE 9 Z-- a REVIEWED BY..... --•-- •-- = ----- •--------------------- -- DATE..-------------------------- $UILDING PERMIT ISSUED_. { . -;- -- - -- -----•-=----------•------- -----------.••---------• ------------ --•------�---------•-••------------------------- DATE Alterations and/or recomm dations:.__i--------- ----•_-- ----•- -------------------------- L/.._� - •---------------------- ---------- ----------- --------- -•--- .................................... .mow."7 .. .____..____.__ _.._ ______---------____________________________________ _ FINAL INSPECTION BY:( �_ ''- C — (' Z A ----- Date--a- _---••-----•----••----------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Shut 205 Wert 9th Street E6 9 REVISED 8.69 2M 5-61 ATLAS Stockton,California Lodi,California Manteca,California Tracy,California