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2 d APPLICATION FOR SANITATION PERMIT Permit No. ._9. _` ,�_.... (Complete in Duplicate) /// Date Issued -- -------- 2 3- Application is hereby made to the San Joaquin Local Health District for e permit to construct and install the work herein described. This application is made in compliance 'with County Ordina 549.. . , - JOB ADDRESS AND LO TION--- ,. Owner's Name--------------- --•- _ -- r -, -------------------------------------------- Phone_-,---- --------------------------- Address---------- ----------- ----------- = ----------------------•------------------ ------------ Contractor's Name-----=---------------- s Installation will serve: ' Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin units: __�_._ Number of bedrooms __ ____ Number of baths ---/ Lotrsize _____ / gt• G'�La��--------------------------- Water Supply: Public system ❑ Community system [I Private L&- 15epth to Water Table ---------ft. r Character of soil to a depth of 3 feet:i Sand ❑%Gravel ❑ Sandy Loam E] Clay Loam El Clay ED Adobe Hardpan E)Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . d (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) `tic Ta Distance from nearest'well__--------------Distance from foundation___________-______-Material___--_________---_..___________.___..__-_______. No.'of compartments___---------__________.__Size--------.----------------------- Liquid depth ----------'-------Capacity-------------------- D sal t Ise.: Distance from nearest well..��_� Distance from foundation.______ -_ -;- - : .____.._.Distance to nearest lot ine____f. 477 u Number of lines___.._=r__ - _ 'Length of each line_ �"/ n g � r Width of trench ---------------------- 4, Type of filter material _ Depth of filter material_____ __ Total length__41 —D_------------------------ Seepage -- ------------•- -- Seepage Pit: R _ 'Distance to nearest well--------------------__Distance from foundation_"___-_--_..____.Distance to nearest lot line------"---------- ❑ Number of pits--------------------- Lining material-----------------------Size: Diameter-----------------------Depth__.-----------------------•----- rr � Cesspool: Distance from nearest,well--- F____-8._Distance,.f.rom-foundation-------------------- Lining material,--------___-___________________.. K ❑ Sizes Diameter------------------ ----- -------_- - --------------- Depth------------------------------------------- -------Liquid Capacity.. ---- -gals. h' Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------------------------------- ❑ Distance to nearest lot-line------------ r --- Remodeling and/or airing (describe):-------------------------------------•------------------------------------------------ -I -------------•------------••- , ------------------ -------- ------- --------- =----------•------------- ----------------------------------------------•--------•-•------ --------------- -------------•---------- -------------- ----------------- -------- ---------------•-- - -- ---------------------_--- ------ ------- •--=---------•------------------------•------••--=-------•--•-------------- -'-------------- I hereby c tify that I have prepay d tis application and that t e�work will-6e done in accordance with San Joaquin Cou ordinances, Sta laws, .a rules and r gula ions of the' San oaqui 'Loc I Health District. --- -------- ----- ---------------------- -------- ------ (Signed) ( wf7�or Contractor) �Y� ------•- --- - ------ ----------; -------------(Title] 4 (Plot plan, showing size of lot, location of sys m in relation`t0 w , buildings, a c., can be placed on reverse side). : FOR DE AlkYMENT USE ONLY i APPLICATION ACCEPTED BY---------------------- -------------------------- ---------------------------- DATE------------- REVIEWED BY------------ --•---------------------'--'----------- -- - ---------------------------------------=--------------------- DATEft a f _ - - -------------- BUILDING PERMIT ISSUED-------------------------------- -------------------------------------------------------- DATE- ---- --- Lr Alterations and/or.-recommendations---------=---- ---- i--------------------------------------•------------ ------------------------------------------------•--•-•---------------------------------------------------- -------------•------------•----------------•---•--------------------------------------------•----------•------- FINAL INSPECTION BY:: It'- ---------=------------=------- ----- - - Date-Z�r_.o2- ___ � .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES-9-2M , Revised 1.57 F_P.CO.