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FOR OFFICE USE: ��-- � �� --------------------- --------- ----------------------- ------ ------------------ ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 9. JOB ADDRESS AND LO ATION------- ----- • 6, a .� Owner's Name r ------------- Address ----- ----- --------------- Address ��1--- --j = ------------------------------------------------------------------- Contractor's Name_ _ I ti n�� J -- -------- s 5 -Ca -------------- Phone-_-- "-'t "`� Installation will serve: Residence [ i partment House ❑ Commercial Trailer Court � ❑ ❑ Motel ❑ Other ❑ � Number of livingunits: _�--- Number of bedrooms ��jj r' r FJ___ Number of baths _�_._ Lot size Water Supply: Public system Community system E] Private El Depth to Water Table -------- ft. .l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: [If yes,date-------------__----.1 No ❑ New Construction: Yes ❑ NoHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . '11 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Tan :-- Distance from nearest well_________________Distance from foundation------------------- Material____._.__.__.____________.___.____....__"""___. No. of compartments--------------------------Size-----•---------•----------------Liquid depth--------------------------Capacity----------------------- sal d. Distance from nearest well.__ _ 11 _D'stance from foundation . ! _______Distance to nearest lot line__i- ___.• Number of lines_______�_ ..___Depth Length of each lineup------- ---Width of trench..,P7154�*__ "".__Type of filter mater of filter mat rial / !f_-Total length_____________t,.. Q--r------ r , Seepage Pit: Distance to nearest well__ - Distance_from founclatiop3iO _ _...__. .Distanc� to nearest lot _ Number of pits____'_____"----______Lining maferialO__n -__ Size: Diameter__Z-Z...... De fk--. Cesspool: Distance from nearest well_________________Distance from foundation...__.__-.__.______.Lining material--.------------- _ __ _._____._ _.____ __._ .-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity ---------------- --------gals. Privy: Distance from nearest we]-----------------------------------------------__Disfance from nearest buifdin ----------------------------------- 0 Distance to nearest lot line_..______ Remodeling and/or repairing (describe):------------------- --------------•--•-------•-"--------------------------------------------------------------------------- .... ---------- ------------------------------------------------------------------------------------------------------------ ------ ------ - ----------------------------- - - - - ---------------- ----------- -------------------------------------------------------------------------------------------- - ------- ------- -------- ---------------------------- I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of the San Joaquin Local Health District. (Signed) -----SEPTIC__ TANK--5E:Z 10E--------------------------k+o -- - ---------------------------------------------------(Owner and/or Contractor) 13y;2915 ------ner Ave., a HD6.384A ------------ --- --- - -----(Title)---------------------------------------- ---------------------- (Plot plan, showing size of lot,Liocation of system in rels, build! s, +c., can be placed an reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- --------------- -------------------------------- ------- DATE----------- -----� $ , REVIEWEDBY --------------------------------------------------------------------------------------------------- DATE- BUILDING PERMIT ISSUED--------------------- -----._ DATE. ----------- -- - ---- -- Altera+ions and/or recommendations:_____,l� -__"".- 40, _. -- - ----- --- - -------- ------ s -- �--�. ---------- -------------- -- ------------- ------ --- ---------- ------------------------- FINAL INSPECTION BY:---------- ..e lll '------------------------------ ---- Date------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F,P.CO.