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WR OFFICE USE: ' .. --------------------------------------------------------- ________________________ APPLICATION FOR .SANITATION PERMIT Permit No. ...f S___Y--Z - k (Complete in Duplicate} / -�i� ------------ This Permit Ex ires 1 Year From Date Issued Date issued _____.... 'S__..3 L �q�(Qa_( 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 Ordinance No. 549. JOB ADDRESS AND LO TION__L ----------------------- ` Owner's Name_."-- _- -- •-• ....:__ Ph - - -------- - - I / - -• � -- �---------•---• ----------------•--- --- one _ _. �l � Address-- Contra or s Name___ .__ t Phone•_ :1 -.01 Installation will serve: ;Residence ❑ `A rtment House [] Commercial ❑ Trailer Court ❑ Mo�010Number of living units: ___ Number of bedrooms __/—:,Number of baths ____ Lot size ��.__-_ ....------ Water Supply: Public system ❑ Community system ❑ Private Depth to-Water Table-ea ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date__________ ________) Nop� New Construction: Yes,Q} No ❑ FHA/VA: Yes ❑ No-' TYPE OF INSTALLATION AND SPECIFICATIONS: k '(No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well.��-�__Distance from foundation- - . �. i Mat nal ' ' No, of comp8rtrnents__ ----------------Size�� ---._..._:._.Liqui dap �. Capacity. I Disposal Field: Distance from nearest well.. 4.____:._.Distance from foundation ____.. ___��. .DTs+ante to nearest lot line___.S____.___ Number of lines_;_._/-_-_-----------(2 Length of each line_.___ ---- --__ _._••Width of trench.__--�-7�_"---__- key P 9 T e of filter ma.tenal _. _______ _----___Depth of filter material____,/Zf__ ._Total length_______-y�.-4-----------------"""-- ++ YP e Pit: Distance to nearest welL �J_�._______Distance from f dation_r....._ _.Distance to nearest lot line___._"""".. h s Number of pits_.�----�------------'Lin"rng material. -Size: Di meter_---.2 _----------Depth-----. -------- ------ Cesspool: ---- See a Cess o P A� •�� p ol: Distance from nearest well_________________Distance from foundation--------------------Lining material-__.___.._-_______________-_____ ❑ Size: Diameter = Depth_ -------------------•--•---------------------------Liquid Capacity----------------------------gals. Privy:, Distance from nearest well__._.___________________________________________Distance from nearest buildin g ----- ---- --- - ❑ Distance to nearest lot line-------------------------------------------------------- emodeling and/or r airing (describe):___ __ tytr ----------------- -- --------------- 1�f------------ -- T/ l --- -------- ---------------------- ----- ---- '� ----- ---------- -------- _� ---------------------------------------------------- ------ 1 � ° ---•-------- ------------------------------------------------------ ,hereby certify that I have pr rared this app anon in that the work wjfi be dd e'in accordance'witli'San Joaquin County ordinances, State la s and r lbs n reg a ,ions the n Joaquin al Health District. r (Signed)-- - -- ---- ----- --- " _.(Ow e nd/or Contractor) By: f -------------•••----------------• ._{Title ---------------- (Plot plan, ho ' e of tet, oca+ion of system in relation to wells, buildings, etc., can be placed on rev a side). { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--------- -------------------------" ----- - DATE__ REVIEWED BY------------- ------------------------------ ----- - DATE------ 10 BUILDING PERMIT ISSUED ----------------------- ---------•------------------------------------------------ DA•TE.--------------- Alterations and/or recommendations:+------------------_---__________ ----------- -------•----•-------- --------••-------- ----------------------------------------------- ---------------•----------------------------------••-------•-- I ------------ ----------------------- --------------------------------------------------------------- --------------------------------------- - — / 4 FINAL INSPECTION BY:----------- Date------ ---/ r ------------------------------------- y 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 REVIEEC 6.69 r.P.00.7M 6-60