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APPLICATION FOR SANITATION PERMIT Permit No. _9 ---------- /r a (Complete in Duplicate) Date Issued _---------1-__-.�_.. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. Pp p with County Ordinance No? This application is made in compliance 549.w JOB ADDRESS AND LOCATION________-_______ �-/--Y-- - Owner's Name------- 5 "-i---- --- --------- Phone {/ -------------------------------------------------------------- Address_ = r..- / ---------------------------------------------------------- Contractor's Name (�i�-_' ---- --------------------------•----------------------- Phone ht-44A4- - Installation will serve: Residence Apartment House ❑ Commercial-'[] Trailer Court ❑ Motrell ❑ Other ❑ 7 V- Number of living units: ___ Number of bedrooms �_ Number of-baths __ _ Lot size ___IJ�I- -A kX-------------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table57�? ft. Character of soil to a depth off 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam E] Clay I[] Adobe Hardpan ❑ Previous Application Made: Yes r]I No x New Construction: Yes El FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-AND SPECIFICATIONS: Septic (Noseptictank toar`cesspool permitted if public sewer is available within 200 feet.) foundation p ncevfrom nearest well---__--.-- iscance from foundr. ----__-.Majerial_?_ r_ ___------------------------------- �� No. of compartments______ Size `sj� ./rs �1._ Liquid dei th 7 Capacity14 -- / '� Q Distance to nearest lot line Disposal Field: Distance from,nearest�wel�I� Distance�rom-foundat�ion__ __ -Q--••• Number of lines___ ____________ Length of each line____ '- SS __�__...Width of trench__ _._ ____ --------------------- • ,V _ ii Type of filter material_- Depth of filter mater al___,� ..____--Total length__.__-.--____ -- ---------------- R 1 �1 / Seepag it: Dis#ante to nearest{�ell A02 -Disfian m f nda_ion___:. Q..___.Distance to nearest lot line_&_ W__1'_ Number of pits------/--------------Lining material�*�/_ _ --Size: Diameter-- - ------Depth---- _�--------------- - Cesspool: � � Distance fromnearest well________________Distance from foundation_____ --------------------Lining material----------------------------------- - 6� ❑ 17. Size:�Diameter---------------------------=----------Depth i - Liquid CapacitY - _. gals. q Privy: istahce from nearest well-----------------'----------------------------1_1Distance from nearest building----------------------------------------- l`\/ ❑ `Distance to,nearesfi lot line` _�._ -------- i --- --------------------------------- - ----------------- ---------- ------------------------------. ------- -•--------- Remodeling and/or repairing (describe):_,______________________--___.__ __. 4►. - i! ---- _ti ------------------------------------------------------------ i- r ------------------------ ------------------------------------------------ -- --------------------------------------------------------------- I hereby qel0y that I have �.epared this application and that the work will be done in accordance with San Joaquin County ordinances, S el aws, d r s a d regulation of A. an Joaquin Local Health District. (Signed)...__--- net a Contractor) -----------------------------•-------- (Ow and/or tor) " -- - ---- ----- -------- ------`---(Title)-- ------------------------------------------- b ------------------- -•-• (Plot plan, showing size;of lot, location of system in relation to IIs, buildings, Oct; can be placed on reverse side). .F f rr iviv FOR DEPARTMENT USE ONLY "ww APPLICATION ACCEPTED BY1-------- ----- ----- ---------------------------- ------------------- ----------- -------- DATE_----------------------- -- �---------------------- REVIEWEDPERMI -----------------------------•-- --------- - -- - 'k -------I------- DATE -• �A ---------------------------------- BUILDING : T ISSU.ED-------1•------------------ ------------------------------=--------= _ DATE 1\------------------------------------------- iAlterations and/or recommendations-------------- -------- ---------------------------------=------` ' -------------- 1!_ ---- 4�_! ----------- i ----- I T - ----•---•------------------------- --- ----------------------------- -- - - - -------+-----'-- FINAL . i INSPECT Date, ;f ":� = "= Date-- � 5 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M (Revises 1-57 FY.CO. i i