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APPLICATION FOR SANITATION PERMIT Permit . +/ (Complete in Duplicate) Date Issued �— r --- Applica�ion 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. P9 JOB ADDRESS AND LOCATION______-__ �' f_ _-__ - e� Owner's Name. ..._ ------- k11P�D� . _ - . - ' Phone ( > L `L � _ N1 one__. ---�---- Contractor's Name-------------------- Address-------------------------------- -•--Address------------•------------------- Installation will serve: 'Residence partment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other [] Number of living unit's: ___, Number of bedrooms S--- Number of baths Lot size ----- Wafer Supply: Public syst _------ . Q em` `" tmmunifiy 'syi stem. ❑� Private ❑ Depth'to'Water Table _______: ft. E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [J Adobe �an ❑Nl% Previous Application Made: Yes R] o ❑ New Construction: Yes E N^ ❑ p, TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.] p est well �----_Distance from foundation__. r{ f No, of compartments p�/ `v -Mate(/'al- No. -------- �.----5ize-----�� n-�-•�-rquid depth_--:.__.l?.Q-"!..-_--Capacity-----��--�--- Septic Tank: Distance from near Dis osal Field: Distance from nearest st wgil _- Q...._Distance from foundation_ _ (,1_.-__.__Distance to nearest lot line--- Numbt - er, of line s_______________ 3.-----------------Length of each line_�S�o- e U-Width of trench.--_.__-_: _ a Type of filter material _Depth of filter material-.___�Cr-----_Total length__________ Seepage Pit: Distance"to nearest well__-��___.--.-_--Distance, rom 'foundation.____..__.... - -stance.to .nearest lot lins___�____ ___ Number of pits-----(/_____------_Lining material-_. ,_j .-.._.Size: Diameter__..- %� "" Depth ------------••-- Cesspool: Distance from nearest wall-------------------Distance from foundation____------------___ Lin ing,material---------------------------------- ID _:__.-______ _--._.________❑ Size: Diameter--------------------- -------- -------Depth-----------------------------------•--------- Liquid Capacity gals. Privy: Distance from nearest well ___._.._.------- ------------------------------Distance from nearest building ❑ Distance to nearest lot lire----------------------------•----------------- ------------------------------------------------ Remodelin`` a or ep ` ing (describe)::-___ . =- - ."- =: >- F _:__:----------------------- ---------- -:,:u::,:�:.:.:�::-m,Xk ---- �� -------- --------------------------------------------------------------------------•------•- ------ ------------ ` ---------- -------:____ :: :: -:::::Q :::::- I hereby certify that I have prepared this application and that the work will be done in'accordance with San Joaquin County ordinances, . to laws, and ruulesndNr�HTions of the San Joaquin*Local Health District. DAY&(Signed}__. Sepfic 'fanlc Servis9 _ ----- r Confract ) 73Gb"3o:_eTdorado HO 2-7- (Signe 7 '' rand/o or By:.-"--- - --------------itockt",f Calitf:------- - -- ----- -- ----- * •. - - ------Title) - ----- -- --------- [Plot plan, showing size of lot, location of system,in relation to we , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY--------------- ------ ---- ---- -- - --- ---------- ---------------- -- • ------------- DATE--- ---- l; REVIEWED BY----- - ` .---- - • -•- ----- DATE-------- / � ----------------------- BUILDING PERMIT ISSUED----`.. '. , . - DATE ak� Alterations and/or recommendations:-`------------------- ----� --------•------- --- -r r-�------------------- - ------------ --------------------------------._..._. �r� `'.-- ��..._ - }• __ alb" X511 --------------- ! ate; 7— __. ----- --------------------- FINAL INSPECTION BY:__ -- ---- Date----- ---- ! -1*�'------------------ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street _ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-214 145446 nrwovo iz-54