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APPATION FOR SANITATION PERMIT—) Permit No. .1. ----------------- --- ------------ (Complete in Duplicate) k ------------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local.Health Districtf r a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 9. JOB ADDRESS AND JP6A N-__-__. '___•_ __ ------ -feta_.... -------•----•---- -------------------------------------------- Owner's Name--------- -A--------------- ----------- - ------------- ------- ----- Phone4-7.7-I&I----- - Address----------- Contractor's Name. - ,�-s� .. / '------------------------------------------------------ --------------- Phone--•- R * Installation will serve: Residence Apartment House ❑ Commercial Trailer Court Motel ❑ ❑ ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ---------------------_-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 267 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: (If yes,date--------------------) No)& New Construction: Yes ❑ No& FHA/VA: Yes ❑ No IV TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) FSeptic Tank: Distance from nearest well--6-27 i--_-Distance from foundation__/��le - ----_._.Material._ G ' - c yl - ----------------- - -------- No. of compartments-___A---- ----------- ?S -- ---6_-.___Liquid depth__4=4 ----------- ----- Capacity--- Disposal Field: Distance from nearest wefi_,S .. ...Distance from foundation-1-2,Q_r-____.Distance to nearest lot line-J.0 .. Number of lines-_ _ - ) ----_Length of each line---_-_._-IJV - _--_3-----.Width of trench_..'e__4__,--._---------------- s Type of filter material- 3,..Depth of filter material----.___ ---__-_Total length--------- Seepage Pit: Distance I-o nearest.well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter---------------------Depth----------------------_ - --------- F Cesspool: Distance from nearest well_---------------Distance from foundation----------------- material-_------.---------------__----__. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity------------ ------gals. Fil Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---------------------------._--- ❑ Distance to nearest lot line-------------------------------------------- ------------------------------------- ---- --------- Remodeling and/or repairing FI ---------- -J--- -•- ---- ------ -•- ----------•----------- -------- ----------•----------- ------ ---------- ------------------------ herebcertif #hat I -- ------ ----- ----- ------ ----- -- ----- --- --------- ---- - ----- ------ ------ y y e.prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d :ru s and regulati s of the San Joaquin Local Health District. (Signed)-------------------------- n - - ----- ------ ----------- --- ----- ------ ----------------- ----------------------- ' _ - .---�re,,, r Contractor) $y:.. , -`-------- (Title) 0 - -- --------------- (Plot plan, showing size of ot, l�ocaatttion of system in relation to wells, buildings, etc., can be place side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .� „-e.n C�, - r�J -------------- DATE-----/7 F.FI � REVIEWED BY-------------------------------- - ----------------------------------- ------- ---- ------------------------------•--- DATE BUILDING PERMIT ISSUED--Z------------------- __-- --- _ -- ---�-- ---- ATE------ -------------- - -- ------------ Alterations and/or recommendati s:._. -__--( -__�__ _ _____ . F- ----------- •---------------- -- -----_ --------------------------- ---------- ----- ------------------------------------------------ i- ------------------------------------(,, -----------------------' - -__ ------------------------------------------------------------ -. ....---`-----------------------`-`-----------------------------------------------------------------------"----------------------.----_----------------------------------------`------------•----------_---.-------- f FINAL INSPECTION BY:. _�.—P-- -� Date------------ �'Jl G SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton, California Lodi,Colifornin Manteca,California Tracy,California i F.a.co.