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�— - FOR OFFICE USE: ---- - -- --- ---- - _______________________ ._________.__. \PPLICATION FOR SANITATION PERMIT Permit No. .../..�; �.�... --------------------------------------------------------- U (Complete in Duplicate) 3 f ` Date Issued ..... -----------------------...............I-----_------------ This Permit Expires 1 Year From 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 OrdinanjNo9. Ordinance S . . JOB ADDRESS AND O ATION__. -- __________ __~______. - Owner's Name �� . Lraj ....... -iPhone„ . `Address------------•------------•-------------- % Contractor's Name-----— . .............. . .C- ........................................... Phone................................... Installation will serve: Residence 0--Xpartment House Commercial E] Trailer Court ❑ tel P Other❑ Number of living units: ---)! Number of bedroom--___ Number of baths `____ Lot size _______________ -''�-••------••- Water Supply: Public system ❑ Community system ❑ Private epth To Water Tabl 7ft. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sand Loam [-] Clay Loam ❑ Clay ❑ Adobe rdp Haan C]Previous Application Made: (If yes,date____________________) No New Construction: Yes to ❑ FHA/VA: Yes ❑ No [Z,.. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well__ _ ...� Distance from foundation,lQ.__!___.__.Ma_ri J�_ '. ..... .__. - No. of compartments__--__ -------Size----- �L Liquid depth........ _ _Capacity Disposal Fi Distance from nearestell__ __'/_Distance from foundation./ ._.._.Distante to nearest lot line,... Number of lines.......... -------- Ell Length of each line./eV'_:__ti!' .,0ZWidth of trench .1................. -------- Type of filter material....... of filter material.../4_.`!----_-Total length... ..�4 ........................ Seepage Distance to nearest well-,lam----------Distance from foundation.,A—Z..___.Distance to nearest lot line...�$__._....... Y v Number of pits----�---------Lining materiaLY__'Q.G..�__-_.Size: Diameter___ --._...__.De the 6•-.----_.•------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------------------------------------Depth_-------------------------------------------------Liquid Capacity............................ Privy: Distance from nearest well-----------------------------------.--------._-Distance from nearest building------.-•_,--__--_-----_---___._-.--__---. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------.......................................... Remodeling and/or repairing (describe):-----------------_------- __________ .. ------------------------------------------- ---------------------- -------------------------------- -------- --------------------------------- ----••-------- ----------------------------------------------------------------•----------------•--•--•-------•---•--------------•-•-•--•-•------------•--•---•---••-----------...--------- I hereby certify that I have prep this application and that the work will be done in accordance with San Joaquin County ordinances, State lawn an ru s an eg et” s of the San Joaquin Local Health District. t = (Signed) . .. ---(Owner and/or Contractor) By:....•--•-•......-•-.•--•-- - ---- (Title). ! /G% (Plot plan, showing size ot, location of system in relation to Ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --- ----•---' ------------------- DATE-•---a-..... �-----•--- REVIEWEDBY----------------------------------------- --------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED......:..................................................I------------------------------------------- DATE............................................................. Alterations and/or re n�men�atlons k -------------•---------------•-.------------------............... -... = ..._._ . . f. r. ,c_—,-------_- --------------� -- -`� ----- %5�/ FINAL INSPECTION BY: ��-� ---- ---------------- �-- Date--- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS