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APPLICATION FOR SANITATION PERMIT Permit No. .9,.� .77_-... (Complete in Duplicate) '. Date%Issueel: Z/e<4/_2. 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 AN ATION.----��.� C L;Z ----- ------- --- ----- Owner's Name ---- .-- ---- _--------._Phone.................................... Address. �t..L.�.- ----------- Contractor's Name................... // Installation will serve: Residence Apartment House❑ Commercial E] Trailer Court ❑ MJatel ❑ Other ❑ Number of living unifs: -.-_ Number of bedrooms Number of baths -_/ Lot size .-__ _ : Water Supply: Public system ❑ Co mun'ity-system�J Private ❑ Depth to Water fable, ft. Character of soil to a depth of 3 feet:," Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loan ❑ Clay ❑ Adobe Hardpan ❑' Previous Application Made: Yes ❑ IoX New Construction: Yes'❑ No FHAYVA: Yes ❑ No F] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) . Sepf T Distance from nearest well Distance from foundation _______ ---------` Matrrel ___________________ No. of compartments--------------------------Size-----_------_---- -----_..Liquid depth-------------V Capacity....................... se field. Distance from near"+ well------------------Distance from foundation......... .........Distance to nearest lot line................. Number of lines_-----------------------------------Length of each line-----_----------------------Width of trench______------------------------ Type of filter material_-_____Sa - depth of filter material _- - Total length...... _.... Seepage it: Distance to nearest well_ ____ ________Distanc f ndation J9 D' nC� to nearest lot (iiia � UR Number of pits.--- _._- __Lining material. -Size. C3ilmeter:___- ,. __�__.Depth.__v ........ ........ Cesspool: Distance from nearest well Distance from foundation ' Lining material. " ❑ Size: Diameter---------------------------------------Depth---- •-------- -------- ---------- ------Liquid Capacity----------------------_---gal;. Privy: Distance from nearest well-___________ ________ ___________ _______Distance from nearest building_---_.------------_------_----------- El -___--._ _._-___❑ Distance to nearest lot line------ --------- .---- - ?0'-4---- -- ,, ._W -. . ---------------------------------------- Remodeling --- --------- ---•- --- .-.Remodeling and/or repairing (describe) ----- - --------- ------------------------------ .................. ----. ----- ----- -- ---•---- ...... ----------------------•-•---------------------------------------------------------------------•----------------------------------------------------•---------------------------------------•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with SanJoaquin County" ordinances, Stat a , and rules and re "ulations of the San Joaquin Local Health District. (Signed) ------------ -• • •----------. ---- _------- - .`..... y ---- -- - ----- • (Owner and/or Contractor)` By:----....................................... --------------- K� " ------lr+lel-- - ----------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------•......----------------------------------------- DATE_,o REVIEWEDBY................................. -----_- ---- --------------------- -------- ------------------------- DATE--.'4k................................. BUILDING PERMIT ISSUED........ ... ----- -----•. --•-•• DATE...,;. ................................. Alterations and/or recommendations -------------------------------------------------------------------------....................................... ---- ----•-.._...-•------------------ -- ..................................... FINAL INSPECTION I $Y:• -- ------- ---- - Date 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 ES-9-2M : Revised 1.57 F.PM.