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APPLICATION FOR SANITATION PERMIT Permit No. . - ___ -9 (Complete in Duplicate)P ) Date Issued .-- Applicati0 .?I,/' on 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. JOB ADDRESS AND LOCATION-._:__-- ,� .. - r Owner's Name--------- ------ -----•---------------- --•-` ---.-•- �I�. Address------------------ - - ----- ------ Phone ----------- r - - Phone--------- --•--------------•------ -------------------------------------------- .. Contractor's Name --.-- --- �FE�] ,Commercial -- -- PhoneInstallation will serve: Residence ❑ Apartment uQrTrailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms - baths - f ----___ Number of ---Z_ Lot size -__-� Water Supply: Publics stem --�-----y` " Y Community system ❑ PrivateDepth to Water Table -------- ft. / Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E3 Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes El No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATI NS: (Nk"epf is tank or'cesspool permitted if public sewer is available within 200 feet.) pfi. k: Distance from nearest well-----------------Distance from foundation-- ` �i F No. of compartments Size LiMaterial •--- Liquid depth----------------- - -- --Ca acit p Y................... ----- ---•--. -- Daspo i I Distance from nearest well--- Q__--_-_Distance from foundation I / Number of lines------------- .�-------Distance to nearest lot line. _______ ------------- ----Length of each line----- c Type of filter material-------- ----- ' 'p~ ---•-Width of trench------- ---t---------------- --------- �. Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------.------------ Distance to nearest lot line_-----.--_----_-_ r ❑ dumber of pits----------------------Lining material------------------------Size: Diameter----------------------- Distance from nearest well----------------- Depth-_------------------------------- Cesspool: /n Distance from foundation--------------------Lining material--__-- ❑ Size: Diameter-------------------------- -----------Depth----------------------------------- ------ - is ------------------Liquid Capacity---------------------------gals Privy: Distance from nearest well--------------- -___-_ Distance from nearest building_-_______________ ❑ Distance to nearest lot line--- ---=---........ � --------------------- Remodeling and/or repairing (describe):- --_--_- ----- ------------- -- ---•---- •--- ---- -- ---- x E '-------------- -z� ---•-------- �z = ----•- ------------------- I hereby certify that have prepared this application a tat the work will bdone in accordance with San Joaquin County ordinances, State laws, and rules and lati:0. of the n J aquin Local Health District. (Signed) •--------------------- r. -'--(Ow BY= and/or Contr tractor) -(Owner d/o a or) -r (Title)--- of (Plot plan, showing size of lot, location of system in relation to wells buil s etc., can be placed on reverse side). FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED Id ?- G-t - ;------,� REVIEWED BY------ DATE {• ` S -- BUILDING PERMIT ISSUED------------------ ----------- ------- -------------------- ------ ------- -------- ----- DATE -------------- ------------------------------------ -------------------------- -------------_-- ---------- ------- ----. DATE------------------ Alterations and/or recommendations:-.---_-__-._.---- ---------------- -------------- -------------------------------------------- -• FINAL INSPECTION BY-..---- __�---------------------------------- Date-------- -- •-_z�- 4 ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Trety, California ES---4-2M Revises 1.57 F.P,CO.