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APPLICATION FOR SANITATION PERMIT Permit No. ._� �..G... (Complete in Duplicate) / ` AtIA Date Issued ---7-l-.3 0A 7- 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 nan a No. 9. JOB ADDRESS ND CATIO __� ! __ ._ ____ Owner's Nam = t "...=-.... ................. ------ ----- -------------._•-- ------------ Phone.................................... r Address-------- ----- .. -•••... ....... ••---- ---------- ----------------- --------------------------------------------- Contractor's Name ' ---`- -- ... ------ ---------------------------- ------------------------------•-----------------............. Phone..............................'.:._ i Installation will serve: Residence Apartment House �j Commercial ❑ Trailer Court ❑ Mot I ❑ Other Number of living units: .____ Number of bedrooms a!_. Number of baths ---I.. Lot size ...`±. !N►-A5�-��1j.......... Water Supply: Public system W-01commun'ity system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam F] Clay ❑ Adobe Hardpan 171Previous Application Made: Yes F] No e New Construction: Yes [;No ❑ FHA/VA:Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic-T—nk: Distance from nearest well________________Distance from foundation_--_................Material...._............................................ No. of compartments--------------------------Size.................. ___....Liquid depth-_--------------------_-Capacity........,.............. ispo ie d: 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................. .......�� Seepa Pit: Distance to nearest ell _ ---Distan #ro f u tion.X4!_-..._._.D's n to nearest lot neer Number of pits _=_..-_-__.__..,Lining ma#erial. __.___` p ize: Diameter ._Depth Distance from nearest well.................Distance from foundation :Lining material----- ---------------------------- ❑ Size: Diameter---------------------------------------Depth-__ .__. ___ __ ___ _________Liquid Capacity .....gals. Privy: Distance from nearest well _______ _-- _______-_ _.__.______Distance from nearest building__----------_---------_ __.._..... p ❑ Distance to nearest lot line---- ---------• -------------- ...................................................... M Remodeling and/or repairing (des r re)______________ --------------------------------------------------------................................------ -----------------------------•---................................................ ---•---- ._...... _-•-- I hereby certify that-1 have prepared this application and that the work will be done in accordance with San JoaquinCounty ordinances, State laws, and rules a gulations of the San Joaquin Local Health District. (Si ned 9 )---- --� t7-G ---- --- --- ------ ---- ---------- ---- ---- --------.(Owner and/or Contractor) By: (Title)_ ----- (Plot plan, showing size of lot,location of system in relation to w buildings, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. . . ________________ ............................. DAT REVIEWEDBY----- ... _- -------- --------------------------------------------------------- ------ DATE.- .._.._... BUILDINGPERMIT ISSUED--------------------------------------------------------------—.............................------... DATE.__----------- -•--- ------- -•------ Alterations and/or recommendations:-------- •--------- ------ ........................._- A-----.......................................... ----------------- - :- --------- . .......... -- --- ---- -- ---••-....._. ---- ------ -, FINAL INSPECTION BY:--------- - -----t` --•- ------------•.! j Date - SAN JOAQUIN LOCAL ALTH 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 , Revisea 1.57 F.P.CO. •