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---------------FOR OFFICE USE:-------------------- ---------- - [�APPLICATION FOR SANITATION PERMIT Permit No. 7.2 --------------------------------------------------------- _1.... x..7.. (Complete in Duplicate) Date Issued ---- _ --------------------------------------------------- This Permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit t co truct and install the work herein described. This application is made in compliance 'th Covty Ordinance . 549. � 1 - JOB ADDRESS AND CATION? . Owner's Name.... �,/. rLf` --� ------------ Address ----� hone .... i Address--------------- ---------..... --- -- -- -----------------------------------------------------............................................... •--- Contractor's Name------_------------------- -- ----------------•----------------------------------- .... Phone.................................. Installation will serve: Residence ❑ Apart nt House [3 Commercial x Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1._-_ Number of bedrooms t!'C._ Number of baths ---I--- Lot size ...�''� ________________ Water Supply: Public system E] Community system ❑ Private Depth to Water Table � . Character of soil to a depth of 3 feet: Sand [9 Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------- --) No [ New Construction: Yes*<Ah No ❑ FHA/VA: Yes ❑ No><' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pLt4lic sewer is available within 200 feet.) Septi Tank: Distance from nearest well-_-- 'O____Distance.frem-foundation..- -l7----.--_.-Mat tial____ ___. .,.. r� a - Na. of compartments p '{ _ 4_,. __Li uid de th_.-._-_____ Ca acit r,?Q_ ___ P -- --- -------- ----Size-!#----�-=-- -- - - q /p. 4�=---- - p Y- Disposal Field: Distance from nearest well-- _.__Distance from foundation-_.9.e?_____-•- D'st nce to nearest lot line_..9�_---- Number of lines------ ___. --- ----- --Length of each line„'rfa_" 7_5A_�th of trench.--.--_- __._._________ Type of filter material__ r--Depth of filter material------L--g-r1__--.Total length---_ ------ ----------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------- --------- 171 Number of pits----------------------Lining material--------..-------------Size. Diameter-----------------------Depth------.----------------Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material_-----_----_--------_-_---- [) Size: Diameter_--_--- -------------------Depth-:.----------------•-----------_ Liquid Capacity--------------•----------- Privy: Distance from nearest well------------------------------------------------- from nearest building------.-----__---------.----__--❑ Distance to nearest lot line-----------•------------- --------------------•---------------------------------•-•------------------•---------------------------- Remodeling and/or repairing (describe):--- --�`"'"='� _.. s = . d —st-t --------------------------•---------------------- --------------------------------------------------------- •-�c"d -r-._ ------------------------------------------------------------------------------------------------------•--------------------- ------------------------------------------------------ ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S--tate laws, and rules and regulations of the San Joaquin Local Health District. 0(Signed)_ !'+_ 5D._/O�fr = {Owner and/or Contractor) By:-------------------------------------------------------•----------------------------- ---------------------------------------------trifle)--------------------------------------------------------------- (Plot plan, showing size.of-lot;location,of system.in relation.to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------ -------------- -------------------- DATE------------------------------------------ ----------------- REVIEWED BY DATE " -------- -------------------- --,?------------------- BUILDING PERMIT ISSUED-------------- -- --- ----- - -- — ----------- DATE Alterationsand/or recommendations---------------------------------------------- ---------•-•--------------------------------•----------------------------•--------------------------------------- ----------------------•--------------------------------------------------------------------------------------...-----------.--_------------------------------ --------------•---------•- --------------------------------------•--------------....-...-•--------------------------------------------------------------------------------------------...._...------------------•-------------•-•-•--------------------- ....-•-------------_---------------------------------•-------------------- ------------------------------------------•------------------------------------------------------------------------------------------------------ ---------------------------------------- - - ------------------ --- -------- ------------------------------•----•----------------------------•------------------------------....------------------------•-------•------- 14S,e&P r / FINAL INSPECTION $Y:.. cl 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 REV I6 EP 8-59 F.P.00.2M 6.60