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APPLICATION FOR SANITATION PERMIT Permit No. .___7.-7---3 - Com" (Complete in Duplicate) Date Issued ----- A to construct and install the work herein described. Applica}ion is hereby made to the San Joaquin Local Health District for a permit This application is made in compliance with County Ordinance No. 9. �7 -1-7 - -------- ------- ----�` ------------- JOB ADDRESS AND LOC O ______ _____ _ ------- ff Owner's Name---- - ---------- --------------- ------------------------------- Phone. Address--- ---------- ------------ ------ Phone----------------------------------- Contractor's Name----- _ __ --------- - Installation will serve: Residence r rtmen# House Commercial Trailer Court ❑ Motel ❑ � [j Commercial Number of living units: _--/- Number of bedrooms _- Number of baths ---/- Lot size -___- Water Supply: Public system �... ..ammunifiY system ❑ ,.-O , "- - stem ❑ Private Depth to Water Tableft• 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam F71Clay Loam E3Clay E] Adobe ardpan.❑ Previous Application Made: Yes ❑ No Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk Distance from nearest well__;___---__--.- Distance from foundation_-______----------.Material----------------------------------------------- No. of compartments--------------- ------ --Size-----------------------•--------Liquid depth Capacity.. �.._ �yr••CDistance from foundation__-- _e-`_Distance to nearest lot line.-- -.------ isposal Field: Distance from nearest well Width of trench__. - _--------------------- Number of lines__..__-___ ___ Length of each line__-____ - --- De th of filter material---._fg-"---Total length_____--`,�`7-------------- Type oT filter materia ___ ----------- p - ______________Distance from foundation__.___-____.___-__..Distance to ne Seepage Pit: Distance to nearest well- ___._ arest lot ine______-____.___. Number of pits--- ------------------Lining material---------------------- Size: Diameter-----------------------Depth-.------------------------------ El - \\1 ❑ Distance from nearest well-___._.-.______-Distance from foundation-------------------Lining material-__-------___._---._______--_--__ Cesspool: --_---Li Liquid Capacity __-__..__gals. ❑ Size: Diameter------- ------- -------- --- ---- -Death--------------- ---•------------ ------- - q P Y----------------- Privy: Distance from nearest well-------------------------__----------------------Distance from nearest building---------------------------------------- Distance to nearest lot line------_------------------------ --------------- Remodeling and/or repairing (describe):__ ------------------------------ --- - --•---- ------and ------ - -- -•----- •---- ------ - - that wor wil ! hereby certify thaat idhave spanpr egulations olf tation he San JoaquinhLocalkHeall heDistrkc}n accordance with San Joaquin County ordinances, a la s, fmr Contractor) --------------------- +-� (Signed--- ---- ---------- ------------- --------- -- --------------- --------- - 'tle) --- •--------- ------ --- -------- -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY----- - DATE- ..- _ DATE--- -- 'S--------e"1� ------------------------------- REVIEWED BY------------------------- -- DATE----------........ -- ----` --------- ---------•---- -------- - BUILDING PERMIT ISSUED----------------------- �---- -- Alterations and/or recommendations:__._______________._ ------------------ ------------ ----------------------------------------------------- NT - FINAL INSPECTION BY------------- -- 1 ---- -- -- Date------ �------------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California Y� r Es-9-2M 149446 nrw000 12-sa