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APPLICATION FOR SANITATION PERMIT Permit No. _ {r (Complete in Duplicate) Date Issued 77 Application is hereby made to the San`Joaquin Local Health District for permit to construct_and install the work he in This application is made in compliance with County Ordinance No. 549.; ... t JOB ADDRESS AND LOCATION------- ------- -- -- ---------------------------------------------- --------------------------------------- -- •- -- ._ !� Pho ---- ----- --------------- -- Owner s Name_____________ --- - -------- -------------------------- ----- ------- ---------------------------------------------- ------ e� � Contractor's Name---------------- Phone _ .__.. Installation will serve: - Reside'nceApartment House ❑ Commercial ❑ Trailer`,�Co�rt ❑ Motes ❑ Other ❑ F Number of I•iving'units: --,/--- .Number of bedrooms a__. Number of baths _!--__ Lot�size ------------------------- i Water Supply: Public system Community system [IPrivate El Depth to Wateriible.5�{ft. Character of soil to a dep+h,of 3 fee+: Sand ❑ Gravei E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan 171 Previous Application Made: Yes ElNo New Construction: Yes ❑ No M' IFMA/VA: Yes El No El i TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.)' y .1-1 .. Sep-'c T n : , Distance from nearest well------------------Distance from foundation_-___;----____.__--.MateriaC '__________._________..______..--_____..____. i 44 No. of compartments- �Size Liquid.dep/hi-- ------- ------ C.apacify.., �. I y ov Disposal Fie Distance from nearest well24, Distance from foundation__+�.-Q____.__Distancertonearest lot li e__<.`--_-_-_ f l Number of lines Width'of.;trerich - --------------- f----------- --- --Le gth of each line____-- Type, of filter material____ tk of filter material_____ f- �� Tofal length_'_-_ --------------------------- p ---------------------•- y� undation_._,�.Q__.___:Distance to nearest lot Seepage Pit: Distance to nearest w I__ _ /.Distance om , Number of pits-------1- �- L-ming material -.Size: Diameter_.� :r__------Depth__ g� ` Cesspool: Distance from nearest well------- Distance"from foundation.''"`_ --. --Lin material______________________________________ El Size: Diameter___ t--------------------------------De Depth -------------------------- ---•----------Liquid Opacity-.----•---------------------gals, p Privy: Distance from nearest well------------------------------...------ =---Distance from nearest building------------------------------------------ 171 Distance to nearest-lot-line_'--"= -------------------- --------- ---- = ------------ ------------- ----------- Remodeling and/or repairing {describe)--------------------- ---------------------------- -----•------------------------- --------------- ------------•.....------------ ----••-•--------------- _ -----e------------------- ----- ---------------------------- } __: ------------ - ------------------------•----•----- ----------------- -------- -=-- . I hereby rtify that 1,have pr ared this application and that the work will be don accordance with San Joaquin County ordinances, t to law nd rule an regul4tion of fthe San quin Local Healt i rich. y _,--.-_---_ __O nor and/or Contractor) (Signed) _._i_ (Title) ------ ------------- --- - ................. ------------ - - - -- -- (Plot plan, showing size of lot, location of system in relation to w uildings, etc., can be placed on reverse side). FOR DEPART ENT USE-ONLY - APPLICATION ACCEPTED BY---------------------------•------ ------------ ------ - ------------------------------------ DATE---------------------------- --�-- --------------- REVIEWEDBY------------------------------------------------------- -- -- ----------------------------------}------------------ pfATE------ BUILDING.PERMIT ISSUED------_----------------------- �------- =----------------------------------=---------- DATE � Alterations and/or recommendations. --- _'" " a �_ l --••-------•--- -----•- ---------•------------------------ = •--------• •---------- -- ---- --- -- - ---•-----------------•---------•----- ---- - ---------------• -------- ---- ---- --- .� ------------- ------- - ------ --- -------------------------------------------- -- -------- ----------- FINAL INSPECTION BY: , -- ' Date •---- l-7__---� _ SANN-JOAQUIN LOCAL HEALTH DISTRICT ° 130 South American Street 30o West Oak Street 132 Sycamore Street 814 Norte^ Lodi, California Manteca, California Tracy,,Cia Stockton, California F is ES-9-2M Revised 1-57 FY CO. i