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APPLICATION..FOR SANITATION PERMIT Permit No. ___1-.-� • (Complete in Duplicate) Date Issued A lira{ion is hereby made to the San Joaquin Local Health Districtfor a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 9. ADDRESS AND LOCATION--------------- -�J L(,�-_s_ --- --�----------------- ------------------------------------- JOB �` rr �rt,�-1-e-- -- --------------------------------------- Phone....n---�- .�►-. -1 . Owner's Name------------------•--------- - ----� '�-------� -------• - - � 'a---- Address-------------•------------ S'D-..4•--------- -- - - ' - f' ,e ... ,�� r — r"------------ �''� -------� ------- --- . .fBbon °-. -.� 7 '• Contractor's Name------------------------ ----- Installation will serve: Residence partment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I D Number of living units: __-�__ Number of be -----Z1Vumber of baths -1--- Lot size J� ------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ---.---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑. Clay ❑ Adobe[,Hardpan ❑ Previous Application Made: Yes ❑ No ®— New Construction: Yes P--Iqo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from ST well-- --Distance from foundation---------------__.Material-_------_.----------------------_-----_---------- ,t No. o mpartments Size_ Liquid depth------------ -------------Capacity--------- ------ Disposal R Distance from nearest well__--------------Distance from foundation---_----------------Distance to nearest lot line_-.-_--_-.-._-_. Number of lines---------- -----------------------Length of each line Width of trench. Type of filter material--- --------------------Depth of filter material---------------- -----Total length-------------------------------------•---- �} }D, Distance to nearest lot line_--- Seepa a Pit: Distance to nearest elL- � -- D-ssta from foundation----- _ - Depth Number of pits.-_-___�____ _--Lining material-- - .l-�1�-�----S�e: Diameter---.-- ._ - - p Q Cesspool: Distance from nearest well-----------------Distance from foundation._- .-._.-- ---.Lining materialy----------------------------gals. " -----------De th--------------------•------------ ------- --- Liquid Capacity ❑ Size: Diameter----------------------- - p � Privy: Distance from nearest well_---------------------------------------------- Distance - -Distance from nearest building------------------------------------------ ` ❑ Distance to nearest lot line--------- ---- - -------------------------------------- Remodeling ------------•----------•-----••-----Remodeling and/or repairing [describe)--------------------------------- --------•----•------------- -----------------------------------------------------•- ------ ---•---------•- -----•-----------•------------------------------•---••----------------------•------------- -------------------------------- I hereby certif that I have prepared this application and that the work will be done inaccordancewith San Joaquin County ordinances, Sta and rules "Ye$*tW4Tof the San_J �n cal'Health Aistrict. Septic Tank Service ndy�ir Contractor) 1206_Sa.,Eldoriado---HQ-2.7-044---- ------------------------------------ -- (S� (Signed) 5toektoe, CaliF. 9 )------ By:.---------•-------------------------------:-------- --------------------------------- --- ------------------- (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. DATE -------- =------------- ------- _ --------------- DATE----------- --•-------•---- •---------- .._._..--------- REVIEWED BY----------------•- --------- ---- BUILDING PERMIT ISSUED----------•-•------------- --------------='---------- ------=--------------- -------------------- DATE..---Z- --------------------------------------------- T Alterations and/or recommendations------------------ ----------------------------------------- ----------------------------- .-- �--5�--��----- --------------------- ---- ------------- ... ----------------• -------- --- -•---------------- Date-------------- -- ----- -------------------------------------------------- FINAL INSPECTION BY:-.-.-__ - _ ---- ---------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tree California Stockton, California Lodi, California Manteca, California Y• ES-9-2M 145446 A7W00P 1254