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APPLICATION FOR SANITATION PERMIT Permit No. 9 L� (Complete in Duplicate) / Date Issued Application is 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. 549. 06-5'- 3 -D e�S•�SS.A1St•l�sU/� x n�� n �, ,{p:� JOB ADDRESS - AND LOCATIL7��N4 - .yt �`�' ''r :.- - _-•........ - .... q-.-. Owner's Name------ .-..--•-----•- Phone_....- Address ..................... - ' -----..---=............--..--•......................----•--- Contractor's Name... .................... ------......•. ..... - _.. -------- ----------•...I..------.. Phone.----.. Installation will serve:! Residence Ef Apartment (-louse ❑ . Commercial ❑ Trailer Court ❑ Motel ❑, Otherx ar��0e1~ Number of living units: ........ Number of bedrooms --. --. Number of baths ........ Lot size ........................... Water Supply: Public system [3 Community system ❑ Private K Depth to Weiter Table ........ ft. Cir Character of soil to a depth of 3 feet: Send C] Gravel El Sandy Loam❑ Clay Loam ❑ Clay,(g Adobe❑ Hardpan Previous Application Mede: Yes ❑ No Il New Construction: Yes m No ❑ FHA/VA: Yes ❑ No Q TYPE OF INSTALLATION AND SPECIFICATIONS: P (No septic fank or'cesspool permitted if public sewer is availabka within 200 5 0 for ie/urr�r+ Septic Tank: Distance from nearest well-----------------Distance from foundqq��lon-..:--_-.----....--.Materiel......_..--..-...--.--. 7C S--L quid depth--------6 -. .._.--.:Capacity----•�J�....-V No. of compartments-..-...._ ------.:.Size--.-_ -.-�C..4T-._ _ •Disposal Field: Distance from nearest well...6�......Distance from foundation---.I�C1.........Distance to nearest lot line....-.g--..... R Number of lines___...------ -...-......Length of each line..-.. s .... ........Width of trench-.----..... y'�--.---_ T 'I, Type of filter materiaL�Y��.__-.--Depth of filter material......'�� --_--Total length........-_-----�V---_------..--.-U' See�age.Pit: Distance to nearest well--.-- "_......Distance from foundation-TA to nearest lot lin e--.�^-. Number of pits----/-------------_Lining maferial/4--CA(----.----.Size: Diameter-�,3...___----.-.Depth---okd'.-.....------••-• 2 Cesspool: �istence from nearest well-----.-.-.-----.Dis+ante from foundation-1..................Lining materiel.--..--..------.--__.------_--.--..-. ❑ Size: Diameter...............................--...Depth-----.................._...-I---•----------Liquid Capacity-•---------- gals Privy: Distance from nearest well..-:..- _._.... ....................._....Distance from nearest building-............-----............. � ❑ - Distance to nearest lot line-----............---`-.....-..........-.....•----------•-------•---------------------------............-............... . Remodeling and/or repairing (describe):__-------------------------t------------------------••-•.' -`- _. - ---------------- t-...----....--..-`-- ......-=----'__-------�- -- - - - —.........-... - -- I hereby certify that t have prepared this application and that the work will done in accordance with San Joaquin County ------. ordinances, State laws and rules and regal, tions of the San Joaquin Local Health District. • `I, ((Owner and/or Contractor) (Signed . .... . ^ {Plot plan, showing sire IoYlocetion of system in relation to wells, buildings 4o., can be placed on reverse side). r ( { FOR DEPARTMENTr,USE:ONLY APPLICATION ACCEPTED BY - T ' --...............-.... DATE_-----f•• - �'f/ - - - - vu REVIEWED BY.........-- �.- - .....•- --— _. DATE - .._. ...... - -._....... •. !- .. -_... - -- -. DATE----------------------`-----•--------•------------------ BUILDING PERMIT ISSUED •-- Alterations and/or recommendations:..--._..................... ............ ..._..........----.....................-•.--.............................._._ --................. -._....._ .._ -----..... -- ....... -.........-----' _--- ...... -.-.._......--•----_......... -------------_--- . _... - - ... - ......---..._.... - ...................-........................-FINAL INSPECTION BY:.. .................---- Date-�1:�/ ............................ --.... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore Sfreet 614 North "C" SA"11 Stockton, Cali{ornie Lodi, California Men}ace, California Tracy, Califorafa ES-9-2M . Revisers 1-57 F.P.CO. _�� _