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\j APPLICATION FOR SANITATION PERMIT Permit No. __ 0 (Complete in Duplicate Date Issued __'�'�{-(-.-�-51_ 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 Cou ty Ordinance 9. �JOB ADDRESS AND CAN-- -------- ------------ . - `------------------ Owner's Name------------- f - -- ----- -- •- - -------------------------- --------------- ------ ----------- -------- Phone---.-------- Address-------------- --•---------- --- ------------5: --------fes Contractor's Name______________ - - Phon,�%_C� :- ,- ------- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/ Number of bedrooms___ Number of baths _/---_ Lot size -12 2 --- -•-- ---160-------------------- Water Supply: Public system ❑ Community system ❑ PrivateX 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 ❑ No FHA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFJICATIONS: �'- (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi T nk Distance from nearest well-----------------Distance from foundation------------------- Material ---______________ o. of compartments--------------------------Size-----------------------•--------Liquid depth--------------------------Capac;fy----------------------- s field: Distance-from nearest-weft --____Distance-from-foundation—f:-___:-_--Distance-to nearest lot line--------- y Number'.of lines----=-------------- w=_ Length of each line-------------- of trench---------------------------,_-- . _ �� _.. ---- Type o iter materia ------------------------=Depth of filter material-------------- ----- -Total length________.___---__---•-----_----------•-•-- Seepage it; Distance to nearest well_L- :''____jC}istance m f ndation--- - .__.Distance to nearest lot line__ ...Number of pits------/----_ --- 9 r ( - ----Linin material__ _Size: Diameter---� _`�-_-__.Depth_---- f�___________________ i Cesspool: Distance from nearest well---------------Distance from foundation_,______"_ -__.Lining,mat erial__---..____.______-----____._______--�R ❑ Size: Diameter--------'---=------------------- I.Depth-------------------------- ---- Liquid lCapacitY---------------------------gals. V� Privy: Distance from nearest well________________--.._---_------_------_--------Distance from nearest building-----_.---- -----_-----__-_- ❑ Distance to nearest,lot,line__----- ;---------------- ------------------ --------•-------•-------- --- ¢ �l Remodeling and/or repairing, describe)_______________________ _I — — -- -- -•---� -------------------------------- -------------------- ------------------ r --------------- 4 ' I---------------•- r 1 1 # 1 I here ertify that I ve epared this applica#ion and.that fhe.work will be done in accord anceiwith San Joaquin County ordinance a e law a jr fes d regulations of the San oaquin Lacal Health'Districf. (Signed ------ -- -- -------------- -- --- --------- ---- (O ner and/or Contractor) # e T F — = 8y:... ------•-------- --------- - --- !c - ----- -s--- •/� [Ti#le] ---------------------------------------------- (Plot plan, showing size of Iat, Iota ion of system in relation to ,,buildings, efc., can be placed on reverse side). .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ —, == =' ------ DATE__-_ REVIEWEDBY ------------------------------ ------------ -----------------------------------------=-s--------------------- --- DATE-------Bl11LDING PERMIT ISSUED.... = f------------•---------------•------- - DATE - ------------------ ---------------------------------------------- ------------- Alterations and/or recommend afions:--------- ---- ----------�=-----'-•------------------•-------•----•------------------•---- --`-• - ------•---- - ---------- ------------ - -- ---------------------------------•-----------------------•---------• -------------------------------- ------- -�`�'---- �-- - - _ - -----------•----•---------------------------•-------- = = ---- ---------•---------------------------------------• ------- -- FINAL INSPECTION BY:------_moi Date_-91- ` J 4L— tY y I ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh'American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revised 1,57 EP-CO.