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A 7.r ` APPLICATION FOR SANITATION- PERMIT Permit No. "-(".�--1---------- (Complete in Duplicate] pate Issued .-- --.1-/� Application is hereby made #o the San Joaquin calOHdenatZ& �h Districtze 549r a permit to construct and install the work herein described. This application is made in compliance with County �� I �'� �✓ -------------- -------------- - - ------------ ---------------------- ---- -- ----------- JOB �r— ADDRESS AN LOC ION. _____ -__ -_ ' Phone. �----- ---------- -------------------- --------- -- ----- - i - ---- Owner s Name-------- - - ---- - -------- -------•------• � `,� / ------------ Address P"_+LJ�`-�-•------------ •- - ---------------------------------- -- ----------- Pone----•----------------- - Contractor's Name---------------- -•----- -- -- ----------------------------------------- Other ❑ Installation will serve: Residence ❑ �.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0. f !_"- N bar of bedrooms _� Number of baths __+�__-_ Lot size �x Q < Number of living units:( Depth to Water TaUe -------- ft. Water Supply: Public system Community system ❑ Private ❑ ❑ Clay Adobe �ardpan Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ y Loam y [I _ T s Previous Application Made: Yes ❑ No ew Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or'cesspool permitted if public sewer is available within 200 fe t/� r { G� - - Ma erial --- ----- ----- ,� "Distance from/oundation__�_"" ----- - Distance from nearest well A— . Ca acit -�- Septic T � ;`�.Liquid depthq--------- -------- p Y •- - -J No. of compartments_---------- +_-----._Size_ _--- - r Distance from foundation 4__"" r' Distance to nearest lot line71 ---------- Disposal : Distance from nearest well, -. Width of trench__.__-- I Length of each line----- ---------------- Number --------------- Number of lines' 9 .-Total length------�6-0-•--------------------- LV - I Type of filter materiae '-- `�'epth of filter material__-. ---- I Seepage Pit: Distance to nearest well__________ _______maDistance material from founaSize:nDiameter --Distance t--Dneep+est lot line---------------- - - i ❑ Number of pits 1-1 ing Cesspool: Distance from nearest well______________ "Distance from foundation----------- ""-----Liquid Capacity gals, ❑ Size: Diameter_---------- ------------------------ Depth---------------------------- q p Y ------ n Distance from nearest building---------------------------- Privy: 1U Privy: Distance from nearest well-______________________" - _ I El 'res to net lo# line.______.._" m I ' ------------------------------------------------------------------------------ -------------------------------------- 1 Remodeling and/or repairing {descrnbe�:_---- ------------------------------ 1 -•----------------- ------------------------------------------ ----------------------------------- -------------------- ------------ = ------------------------------------------------------------ ----------------------------------------------------------- - - _ --•------- -------------------------------------------------------- i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws, and rules r ulations of the San Joaquin Local Health District. r ____[Owner and/or Contractor] IXSigned) - ---------- -- ( p ---- ----------------- ------- I Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be.placed on reverse side). 9 � FOR DEPARTMENT USE ONLY -------- DATE------------------------- -------- s�------- APPLICATION ACCEPTED BY := DATE-------------------•--- -- --------------- �� REVIEWED BY----------------------------------- ----------------------------- - =-- - 6- ------ _ DATE--------- - -;�'-- ----- ------------------ - BUILDING PERMIT 15SUED- ' ----- -----------------_-------------------------------- Alterations and/or recommendatio s __._ "" --•- - ------------------ --------------- ------------------ --------------------- •--•-------- --------------- ------------•------------- 1 — -- ------ ------------ - - -- -- -- ---------------------- - -- ----------------- - --- --- `• lam . '------------------------------- --- ----------- -------------- Qate__-- -- FINAL INSPECTION :.-- - -�- �------ --- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT j132 Sycamore Sheet 814 North "C" Street 130 South American Street II 30o West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M , Revised 1-57 FY CO.