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�� • J APPLICATION FOR SANITATION PERMIT Permit No. .�l... .�...r: Com late in Du hcate / ( P P� ) Date.Issued'.. _`f..r 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 wit ounty rdinance o. 9. JOB ADDRESS D ATI -- -- -- -------------------------- -- --------- --.-- --- Owner's Nam ..... ...........-•• •. --•----- •------- Phone------------- - Address------------------------ ------ -• -------- - --•-- Contractor's Name -=�'`--- -- -- -- ------ --- -- ------------ -- -------• --- ------ Phort C�i_41-W&I Installation will serve: Residencej$' Apartment House E] Commercial,[] Trailer Court C] Motel Other [] If e Number of living units: ____Number of bedrooms C;_1- Number of baths ._/_ Lot size ._- - __:.l-_-;�-3---------------- Water ------ --------- Water Supply: Public system ) Community system ❑ Private ❑ Depth to Water Table-ST-ft. Character of soil to a depth/of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ :°Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No F-1TYPE OF INSTALLATION.AND SPECACATIONS: XX . (No septic tank or'cesspool perlimiffed if public sewer is available within 200 feet.) e is an s Distance from nearestwell __Distance from foundation....................Material----------------------------------- Z No. of compartments_.__ e---------------- -------------Liquid depth------------------ -------Capacity ---. r Disposal eld: Distance from nearest"`w IV�4_-_ - :_Distance from foundati Distance to nearest at Imre -5..... Number of lines. .--__-__�---,---- Length of each line.. l0_ _.Width of trench- --.-•-- .... 1�1T Total length----------- ------- a_+_:.-, Type of filter materials-�s - _ - +Depth of;filter matenal._._R,,l_ .____-. See pa t: Distance to nearest well/� _____Distance m f ndation___ e _•_..Dista�� to nearest to line Number of pits.-__..1____- ____ Lining material__ »------------Size: Diameter...__-___.___: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 building_- --._-_-_ _-----_-_ __---.--- ❑ Distance to nearest lot Ime---- -- -- -------- ----- --- --------- ------------------- ---------- -------- -- ----- -•-•-----•-- --- Remodeling and/or repairing (describe):_- -------- --------------------------------- --------- -------•------------------•-----------•--- -------------•------ ------ --... .---•--•- .---- ------•-------•------•-• - -. --------------------------------------- -------------- ---------------------- - I here b -e ify t t I have pre ared this a ation and that the work will be done in accordance with San Joaquin County ordinances, tat law and rules'b regulatio Ythe San Joaquin Local Health District. (Signed) - ---- ---- and/or Contractor) By:.....•------•----------------------- -------- -•-•---------------•--•-(rifle)--------"wrier ------ (Plot --- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------- --------- -- -•---- DATE------------------------- -- --------------------- REVIEWEDBY------------------------------- ----- ---------------- ---------------------------------------------------- DATE----•-•••. BUILDING PERMIT ISSUED............. ------ -------------------------•-•-----•-----•------•-• DATE.............. .. Alterations and/or recommendations:_____________ E, .. -_•_.. ............................................ ........................./. ._......._._................._ ---- .G ---------------------r&,c-----1��Ip C�rad ':= --------------------------------------••------..__...--------------------------- ..............................-----•-----------•-----------------•------------------------------------------------------•--•---•••--•--.... ---------------------------- -------- -------------------------------------------------------- ---------------------------------------------------- ............................... .------------• FINAL INSPECTION BY:---------- IAN U_1�----------------------- Date------------ -��----- ._. ..-..._.. . ...._-----......... 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 - Revises 1.57 F-P.CO.