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AFPL]CATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---�_41_1-� made to the San Joaquin Local Health District for a permit to cornstryclqncll install the�Wvo k herein described. —A c�fi6r.,; gpli`t T Is application is made in compliance wi±L,#_Counfy Ordina e No. 9. -- - ---- -- -- ----------- ----- --- ------ -------- JOB ADDRESS A D C ------ ----- Owner's Name_..____-- ------- - --- --- ---- ------------------------------- --------------- Phone / _ --- - -- -- - ------- - Address------------- --------------- -- -- --- - ----- ----- Contractor's Name----------- --c------ -------- -------- Phone----7- Installation will serve: Residence Aparfm nf House ❑ Commercial E] Trailer Court E] Motel E] Other E] Number of living units: I--- Number of bedrooms 1-- Number of baths I--- Lot size -4-Z2---X_ •5W_---________________________ Water Supply: Public system Community system F] Private E] Depth to Wafer Table ZI& ff. T" I Character of soil to a f3feef: SandEj GravelE] Sandy Loam d CiayLoam E] ClayE] Adobe Hardpan Previous Application Made: Yes E] NoNew Construction: Yes [:] No A K (LA 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 from foundation--_--------------Material------------------------------------------------- ❑ No, of compartments------- ------------------Size--------------------------------Liquid depth--------------------------Capacity.--------------------- Disposal Field: Distance from nearest well______.__.__`_._.Distance _D'stance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines------- ----------------------------Length of each line------------------------------Width of french-------------------•--------------- Type of filter material-------------------------Depth of filter material------------------....Total length---------------------.-------------------- - Se e Pit: Distance to nearest well_/_Ydff_e_.___Distance from foundation_ --- --------Distance to nearest lot line-1-10----- Number of pifs__&*��-------Lining mate rial-16-0 ,___Size: Diameter_3r3Y---------Depth_ '7 5-1--------- V -1' _47f"�---- ----- Cesspool: Distance.from nearest well-----------------Distance from foundation--------------------Lining material_-_-____.____________________.._____. ❑ Size: aterial------------------------------- Size: Diameter------- -------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------- als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------ ---------------------------_ Distance to nearest lot line-------------------------------------------------------------------------------------------- Remodeling and/or repairing --------------- - - - ------------- ------------------------------------------------------------------ ----- --------- ------------------------------------------------------------- ---------------- -------------------------------------------------------------------- ---- --------__-.......- ---------------------------- ------------------------------------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------- I hereby c that I have p eared h application and that the work will be done in accordance with San Joaquin County regulations f ordinances. St e laws,,ar5d rule an ulationsfhe Sa aqui ocal Health District. ` .............. . ... (Signed}_... -------- - ------------ ----- ------- - -- ---- --- ----- 0---(Owner an_d/oj�Confractor -- --------- ----- -- ----------------- By:....... --- ------------Z'_!�------ __(Tiflell------- ---- ------ (Plot plan, sho , size of lot, location of system in relati to wells, buildings, etc., can be place!on�r,,,rs, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 134- ---- ------------------------------------------------------------------ --- ---------- DATE--—---------------------------------------------------- ........... _.._ _ -, V REVIEWED BY---------------------- -- ---------------------------------------- ------ -- --------------------------- DATE ------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---- t--- ---------------- Aylfdral ons art�Lor recornm0dationl:--- t--------- - -------------- -- --- --------------------------- --------------- ------------------- --- ---------- ---------- ---------- ----- -------- ------ ---------t-1---------4--------- ----------- ------�-_. - - -------- --- ------ --I-,o _1 -------------------- ------- ---------------------------------------- -------- ------------- - ----------------- ---------------------------------- -------------------------------- --------------------------- ------------------------------------- FINAL INSPECTION BY.. ----- Dare---- -------------------------------------------------------- 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 8-51 Revised W-2100