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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 9 - 'j ha r1A work herein described. L Application is hereby made to the Son Joaquin Local Health District for a permit to const ruct anPi611 This application is made in complianc%X th County Ordinance No. 54,9. ----- ------- JOB ADDRESS A D� __ __9- jCAT N...-.- - - ----- --- ------- A----------- --------- ----------------------I---------------- Pane--------------- --A-------Ya Owner's N e A-----------I-*,--- __ - __1 __- T 'J�4 i ----------- ESS A D, "e _. Address------ -------- ...........j.. ......... --------------- --------------------------------------------------------------------------------------------------------------- Contractor's Name-- ----------------------0------------------------- ------------------------------------------------------- Phone----------------------------------- -- ------- - - --------------- Installation will serve: Residence - Apartment House E] Commercial E] Trailyr Court 0/�ote� E] Other E] Number of living units: -------- Number of bedrooms __3__ Number baths 1-71 -- Lot size --------------------------- Water Supply: Public system El Community system El Private Number to Water Table ------ ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy-.Loam _' Clay Loam Table E] Adobe Ej Hardpan El,,,'�- Previous Application Made: Yes E] No W New Construction: Yes ;r-'No El TYPE OF INSTALLATION AND SPECIFICATIONS: m. (No septic tank or cesspool permitted if public svwer is available within 200 feet.) Sepfic,eTank: Distance from nearest well Dist end fr ffou �tion-----ta-----Mafe�r al___ -- --------- --- ---------------- X oaci;v. [Fr No. of compartments---------- - -- -------Size-------------EX Se'----Liquid depfh.............�Kl----------Capacity--- ---0-0- __- Dispoyf Field: Distance from nearest well- ____.Distance from foundation__� ----------Distance to nearest lot line ----------- Number of knes----- Length of each line________________ _t_________-Width of french .. .... t �,De of filter material------- ........ Type of filter mater-i-4-- -----------Total length--------i__,FP--------------------- Seepage Pit: Distance to nearest we11----------------------Distance from foundation--------------------Distance to nearest lot line______________._ ❑ ine---------------- El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool., Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity---------------------------gals. ------------------ Privy: Distance -------------�_-�-�Disfancesfrom nearest-building-.___------------------------------ F1Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------- - N ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------------------------------------------i ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- (---------------------------------------------------------------------------/ Owner and/or Contract By: (Title)---------------------------------------------------------------- (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 APPLICATION ACCEPTED BY--(f - ------ - ---------------------------------------------------------------------------- DATE ----------------------------------------------- REVIEWED BY----------------------------- .. ---- -------------------------- ------ - - ------------------------ DATE--------- --------------------------- -------- BUILDINGPERMIT ISSUED--------------------------------------------------------------:------------------------------------------ DATE--------------�.Z-*-------------------------------------- Alterations and/or recommend0ions:---------- ------------ ----- -------- -----------------------------------------------------------•--•-------------------------------- - ---------------- --------- -------- ------------- ----------- ---/-----r---------- ------------- ----------------------------- ------------ ,-I--Z--- -------;-------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- ------ ------------ I ------------------------- ------------I- ----------------------------I--------I----------------- ----------- ------------- ---- ----------------------------------- -----------------),-------------- 14 AO FINAL INSPECTION BY:-- f Y --------------------------- Date-------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8.51 Revised W-2100