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'E ry�� ' ApPLICATIOW FOR SANITATION PERMIT Permit No. �a 3- �.��`� (Complete in,Duplicate)°r � ` `• wi Date Issued ---- -5�1--- Application 'is hereby-made to the San Joaquin-,Local Health District for a permit to construct and install the work herein described. This applicatiori is.made.in compliance with.County Ordinance No�4 D 2 k Ifr� .4 ,. JOB ADDRESS AND TIO . -- --- k _: r d. Phone. --. ----------f ---------- ---------- Owner'sr o Name------------------ Y. .�. - "{ ---------•-- ------------ - --- -- --------o2"�L _. ...... Address_.._____:__- 1 Phone_ - Contractor's Name--------- _ Installation will serve: l Reside e El-Apar ment House .. ---Commercial ❑ Trailer Court ❑ Motel El. Other ❑ v Number of living units: :.I__ ours . Number of baths .-�._._ Lot size _ . Number of;bedro _- ---- , Water Supply: Public's stem Community system ❑ ,v—ate ❑ 'Depth to Water Table PP Y� y k t. . Sand Loam ❑�Cl y L am ❑ Clay ❑ Adobe'( Hardpan ❑ Character of soil to a`depfh of 3 feet: Sand ❑ Gravel ❑ Y No ;New..Construction: Yes El No "FHA/VA Previous Application Made: Yes ❑ No : Yes El f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'oricesspool permitted if public sewer s available within 200 feet.) x i3istance from nearest well .._ Distance from foundation - �__- Material........ ------------------------ is T Liquid.de th----- ----I Capacity-- - ---- -------- t '" Size--------------------- q P. } t No..of compartments..�-_.".._.............. Distance from nearest well..- ---Dista e-from foundation._.-----------------Distance to nearest lot line.... osal = ,,�,,,,,„,..,i De"th of�filte material------------------------Total w{of trench------------------------------------ ------- ------------ --- ----- Width _ ------------------------------_ length�_.----•----- -- - t, Number of lines ------- -- ------`-Length of each line of filter material-______ ________________ p . . Y ^ _ Y ' Distance to nearest we'll -`Distance fr fo ndat.ion.._�__ --_.:._ .D'st ce to nearest lot line_ Seepage Pit: Sizer Diameter..- rJ-__-Depth---.-cn -r:---------- _..-Linin material-_._- --- I ----------- -Number of pits_-___�----:-�=- 9 undation.: Lining.ma-Penal------------------------ --------- Cess ----- l� Cesspool w w Size Diameter nearest well-----------------Depth ce from fo - --Liquid Capa�ity---------------------------gae s. ❑ _ Distance from nearest building- ------- --------------••------,-------- Privy: Distance from.nearest well--------------- --------------------------------- _.--------------- ----------------- -- to nearest lot line_- __ ------------------------------------- -Distance ❑ r Remodeling and/or repairing (describe:"-__ _ -: ------------------------- --------------------"---- ----------------------- -------- ----------- P --------- ___________ y yp P pp JI,, n Joaquin ocal Health District. '. tions application 9 Joaquin County --------------------- --------- ---- ---- -- 1 here6 certif that l have re aced this a lication and that the work will be done m accordance with San ord+Hance tate laws, and and egulak "N �ules e--- --- f o tr cSined .( - C n a tor) ----------- ----------- By=-----------=----------•----•--- ---------- -- -(Plot plan, showing.size of lot, location of system into wells, ildings, etc., can be placed on reverse side). . s R PEPARTMENT.USE ONLY DATE-------- r 51------------------- •._ APPLICATION ACCEPTED i3Y_.:._1-'-R-'R' t ----------------------------------- DATE----------------------- ---- - REVIEWEDBY-------------'-----------------`-----------------------------.--- ;--------- -----.--------------------- BUILDING PERMIT ISSUED------------------ --------------- ------ DATE---------------- -------------------------------- Alterations and/or,recommendations:..-y._---------------------------------------------- % ---------------•------------------ --• ------ ----------------------- •• ----•------•-----------------------------•------•------"------- ------------------- -------- --- -- .. --------------- -- - - � Date- -- ---------- ----------- FINAL INSPECTI —BY::. ..... -"----- -- :_ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ 130 South American S+teat Trac Stockton, California Lodi, California Manteca, California y, California ES-9-2M , Revisea 1.57 F.P.CO.