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APPLICATION FOR SANITATION PERMIT Permit No. ._!!_-/.... (Complete in Duplicate) J_�__ d Date Issued .___ �_ _____. Application 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. JOB ADDRESS AND LO ATION_.__.__ - '_13------- -- - -'_r Owner's Nam ' ' �'� ' I'_e;ArZ'•�c ------------------------ Phone__ '?- z� Address_ ' ----:y^ -e- - Contractor's Name----- 4 �< ... Installation will serve: Residence,' Apartment House ❑ Commercial ❑ Trailer Court. ❑ /Motel ❑ Other ❑ Number of living units: __J___ Number of bedrooms Number of baths I___ Lot size ---___________--_____-_ Water Supply: Public system,' Community system ❑ Private ❑ Depth to Water Table,?4:� ft. 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 IV No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-� .� __Distance jr' m f9undatign_-i�_�'�__/__M ter I. __,,1 .t /-. _--_. No. of compartments____...:_ ____._--_Size_ _.> •`_-.,_:-=__Liquid depth _7------Capacity-___0 _, + Xv Disposal Field: Distance from nearest well_________________Distance from foundation---.---------------.Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line-------------------------------Width of trench----------------------------------- 1j Type of filter material----------_-------__-----Depth of filter material-------------------_-__Total length------------------------------- Seepage __-__-___-_-_-__--____-_-__-__See a e Pit: Distance to nearest/well__ ____-__Distance from fo ndation___ Distance to nearest lot line_.1>-----_-.__ �J Number of pits_.---1_---------___-Lining material,;__r._�__.Size: Diameter_____4_____________Dept h_____/S--'-_-----__---____-_ Gn 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)_____________ _ _ ' _ "_ _ _ _ -----------------------------------------------------fi------------------ -------------------------------------------------- -- 1 ----------------------------•--•----------------------------------•-•------•----------------------------------------------------------.___---'.__------------------------------------------------------------------------- a -------------------•---- -- ----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, apd,rules an�regnfations of_ft a San Joaquin Local Health District. r Y (Signed) " - � .-:;V ---------------------------------------------------------------- -Owner and/or,Contractor) B Y� --------------------------- -- ---------------- -- - Title '- -- �; (Title)-,-- ------ (Plot plan, showing size of ation of system in relation to wells,buildings, etc., can be pl on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- . _ _ ____.:_ - ��✓ �- "/,r -----------------------`---------- -- - --------------------------- DATE------- ---•%?----�--`�'`-------------------------- REVIEWEDBY----------------------------------------------------------- -------------------------------------------------------------- DATE------ ------------------------------------------------- BUILDING PERMIT ISSUED------------------- y f r �---=a -• --------- DAT -- ---------------•----------------- , f'r} ,�` Alterations and/or re ndations:__ f _ted t j __._ _.__ _ _ _ r __j�J a ----! ---------- , �' i s '�i..1!!-_=I.e.r�C ",`-''-�"- �' ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ._,. t � ` - ----- - -L---- --------- -----------�-i-F - - - -- - .Lt --r - - `�- --- - '-'•-"` -_<.T_._r�,.". - ----- —------- - ------ j -' -_ FINAL INSPECTION BY:------- == ----------------- Date----------- --- - / 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 10-52 Revised W-2100