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. U/` �/moo I � cl APPLICATION FOR SANITATION PERMIT Permit No. _I.ZL._>.'n j_ (Complete in Duplicafe) This Permit Ex fres i Year From Date Issued Data Issued __"�"� `""--"� Application 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 rdirel- --------------- ------- No. 9 JOB ADDRESS AND L CATI N .- '"�!_ i - - ----- ' Owner's Name � �"�L . _: - Address - --------------------- a one f ----------------------------------------------------------------- ••---------------•• h Contractor's Name ----------•------------------- ---------- - -----•--------------- ---------------- Phone.---•--•---•--------------...------ Installation will serve: Residence J/Apartment House ❑ Commercial # t�� ❑ Trailer Court ❑ Mofiel Other ❑ Number of living units. _/-- Number of bedroor so Number of baths _ __ ' Lot size .. _)---------------•-----•- Water Supply: Public system jK Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay € ' Y ❑ Y ❑ y ❑ Adobe._ Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ NoJ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tin Distance.from,nearest well ------_---Distance from foundation___-_____________-Material___-_______________- F __._ No. of compartments ---------------Size-----•-------------------------Liquid dept_. Capacity' ispos Field:` Distance from nearest well__"" Distance from foundati n f _ ___._pistance to nearest lot ine._ ----- Length of lines , _Length of;each line_ ___--- dth of trench � Type of filter mai'riaL__ . [ Depfih of filter material__-_,� '_-`---Total leng#h-------- -------- i I -'� / Seep e Pit: �' 'Distance to nearest well____-----------Distance fo ndation----/0.-------D' tanc tp nearest to line__.__ ry Npmber of pits-,..-/--- "-- -_ material__ _(P_---Depth----- ---------- O Lining <-Size: Diameter Cesspool: . Distancelfrom nearest well__---------------Distance from foundation------------- ____.Lining material_____________ —. ❑ �: � � S+ze: Diameter------------ --------'------- -------Depth-------------------------------- Liquid Capacity gals:` Privy: Disfiencerfrom;nearest well-------------------------------------------------Distance from nearest buildin I-' Distance Ito nea est lot i.ine�________________ 1 1 ,, ----------------------------------------- ------ r Remodeling and/or-repairing (describe):--,.,(_______ ' r- Ii ! -------- -------------------------••-------•--- i------•----•------- --------- - --- ------------------------------------------ ---- _ ----- ----------------- _ t ------------------------- -- --------------------------------------------------------------------------------------•------------------------------------------------------------- -- I-here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances,.State laws, and rules and regulations of the San Joaquin Local Health District. y i'. '� -F-- .___z*#-�.�....-.tee.•.-�..t,�.v ,� (Signed)---4,-- -�t�/O - - 1 r • , /!` -------------------- -----------------------------------------Owner and/or Contractor) By:---------------- ----------- ---_--`------•-� ------ - " , ----------------- (r+le) -., _. - ---- --------------- ---- ------ y x P r 4`M __-._______ Pot plan, showing size of lot, location of s 'stem in'relation to wells, buildings, etc., can be laced on reverse side). ' tf FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - DATE "L ?- ------------------------- REVIEWED BY --------- - DATE------ ---- -------- --------------- •------------- ------------ - --------- BUILDING PERMIT ISSUED---------------------------- -------------•----------------------------------------- ------ ---------- DATE---------- ----------•- '. Alterations and/or:reca iiM6ndations:-- ------------------------------- { -------------------------------------------------- R _ =_ `'----- - ---- ---- - -- --------------- •--------•--- ------------------------------------ FINAL !NS ON 8Y Date r(.! rr SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California P s ES-9-2M Revised 6-'59 f.P.Co. �- '