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i APPLICATION FOR SANITATION PERMIT Permit No. ._.- 9 *, ote in Duplicate) q I/► Date Issued Application is hereby made to the San Joaquin District for a permit to construct and install the work herein described. Thisapplication is made in compliance with Cou549.�! /JOB ADDRESS AND LOCATION_._+_y1j�" - ___•-_-/_fit ?___ f'lft9 •-- ---------- Owner's Name---------- __ �p__�-----•--// ----------------------------------------------------------------------------- Phone--------------------•--------------- Address---------- f,---------------------------------------------------- --- -----------------------.. s Contractor's Name--- a-- ---------- ------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms !!!�Number of baths _-_-/__ Lot size --- -------------- Water Supply: Public system ❑ Community system ❑ Private�F4_..Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamtgL.Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes No5<---t,&\4 Construction: Yes No FHA VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public;ewer is available within 200 feet.) i Septic Tank: Distance from nearest well..___. Distance from foundation_hf___-------Material---------------------------__________----- .. No. of compartments-_�/__-_-_.___-.--Size_�y2�n ._ �_�'__-Liquid depth----4—P�1---------Capacity_.._� fl-___-- Disposal Field: Distance from nearest well -0_ _._Distance trom oundation.,,�6---____-Distance to nearest lot line-��- /�' Number of lines---.-I-------- _________ _ Length of each line________��___--------Width of french-------- V-1- Type of filter material__ _! s__Depth of filter material.-- _1j?'(-----Total length----------- _______ l ` Seepage Pit: Distance to nearest well-------------------__Distance from foundation.........•----------Distance to nearest lot line__-•-__-_.___-- "V ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------.-----Depth----------------------_-___._--_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-__..______-_-____-____-________. ❑ 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):---------------------- ------•---------------------------------------------------•---- -------------------------ffify -----•-----•---------------------------------------------------------------------------------------------•------------------------------------------------------------------------ I hereby cha I have prepar is application and that the work will be done in accordance with San Joaquin County ordinances, d rules and reg ions of the San Joaquin Local Health District. (Signed)------------ -� /� - ------ ---- --------------------------------------------------- By: ----- caner an actor) By:----------------------------------------------------------------------------------- ----- --------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of syste in t ells, uil Ings, ., can be placed on reverse side). FOR DEPARTMEN SE APPLICATION ACCEPTED BY--------------- ----------------------------- ----------------------------------------- DATE..... r_. REVIEWED BY-------------------------------------- -------- - --- - - DATE---- r f ---------------------- BUILDING PERMIT ISSUED---------------- ------ •-- ••.-. ---------------------------------- DATE------ ------�----- --- Alterations and/or recommendations:- ' ---------------------- --------------------------------------------------------------------------------------------------------------- 0.7 ._ .-_ _7. ! --�----- Z�w------- ------ ----------------------- ------------------------------------------------------ ----------------------------------------------------------------------- ----------------------- --------------------------------------- FINAL INSPECTION BY:.-00--- --------------------- Date-------�__-/-- ----------1�-�--------------------------------- 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-9-2M Revised 1.57 F.P.CO.