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APPLICATION FOR SANITATION PERMIT Permit No. _9s-7-.- (Complete in Duplicate) `� This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the war rein described. This application is made in compliance with Count Ordinance 5 9. JOB ADDRESS AND OC ION-- ---� __ _____ _ - ----- -- ------• - ---�_, rr� -4��•----- Owner's Name------- ------ .- -- - - - ------------------------------------ Phone------------------------------------ Address.-. ' -------•---- ------------------------------------------------------•--•-------------------------------------------------------- A may Contractor's Name---------------------- . •.--I �r -------------------- ±-------------------------------------------- Phone--------•-•-----•------------------ Installation will serve: Residence 2"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other F1Number of living units: __�___ Number of bedrooms S.- Number of baths J--- Lot size- - -------- ________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 2-11sandy Loam ❑ Clay Loam '"Clay ❑ Adobe❑ Hardpan ❑ �\' Previous Application Made: Yes ❑ No gr New Construction: Yes 0�o ❑ FHA/VA: Yes ZNo ❑ 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public 14 sewer is available within 200 fee+.) Septic TO: Distance from nearest well_-------Distan rom foundation---,�-_____ _ y R / pp�� ), _ .Material____ _ .._ No. of compartments____I—______________Size__i2____k_c[0-----Liquid depth------ ---------------Capacity_. Disposal Field: Distance from nearest well._'_ P__._._Distance from foundation__ __� Distance to nearest lot line--- Number ------------ Number of lines__________ JJ''__Length of each line___-_f ._----- __��__----Width of trench-_ !__________________ Type of filter material 1��/C�_Depth of filter materia ---____._.Total length---------e�------------------------� Seepage Pit: Distance to nearest well_.�Q0_�__Distance fr m foundation___ft.------.D'st once to nearest lot line�___AP__1.__ Number of pits_____ _ _____________Lining material__ _ jP_ ..Size: Diameter _ _r _., Depth___ ___~_��..__._ Cesspool: Distance from nearest well-----------------Distance from foundation------------_------.Lining material__--___._____..____._____.__________. ❑ Size: Diameter---------------------------- - Depth-- •-----=------------------------------------------Liquid Capacity-------- ----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest budding--------------------------------.---_---_ ❑ Distance to nearest lot line________________________________...___________-_________ _ ------------------------------------------------------------------- Remodeling and/or repairing (describe):------- -----------------------------•--------------------------------•---- ------•--- •------------------------------•---------------•------------------------------------------------------------------------------� - - - -- --------------------- ------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---.- Contractor By------------------ ----,s = (Plot plan, showing size . j�j - -----------------------------(Title} (��-'---- -------- -------------- of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ' -'--- - ---------•-------------- DATE----------- JO ------------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------–-------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:--------------------------------------------------- l --- - __ ----------------------------------------•------------�i_r---72s_k." H------ - ----------- ------ Qc ------------------------------- --- ---------- ------ - ---------------- --- ---- -------------------------------------------------- ----- -- ---------------- ---- -- - ------ - --------------------------------------- ---------------------------------- ---- ---------------------- - --------------- .......... ------------ -- --- -) - ---- --------- - - -- -------------- ----------------------•--------- -------------------- --------- ------------------------- J FINAL INSP B f '( Date rl- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cafifornia Lodi. California Manteca, California ' Tracy, California ES-9-2M Revised V59 FT Co.