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U APPLICATION FOR SANITATION PERMIT Permit No..-/__.�---- -` in Duplicate] (Complete d Date Issued -��-3 This Permit Expires 1 Year From Date Issue 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 Ordinance 549. �T S .�f..� ------------------------•---- ---------------------------------- JOB ADDRESS AND OCATION_________________ --- ----- - ------- Owner s Name ----- --Z -- - ----- -- ------------------------ ------ ---- Phone Address -------------------------- =---------_--------- = ' ------• ------------- - ------------ Phone--•-�-�- •-�/`.__ Contrector's Name-------------------------• - -----------------•----- --------------- -- --- Installation will -serve: Residence [�-�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j i le - Number, baths __ --- Lot size _ S_4 -------------- -------------------- ------- Number of living units: _/-- Number of bedrooms _ 1 1 s Water Supply: Public system ❑ Community system ❑ Private 941`6epth to Water Table -Y_4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �iardpan ❑ Previous Application Made: Yes ❑ No ®___I�ew Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , t nk; Distance from nearest well_________________ Distance from foundation ------------------- Material ------------------------------------ of compartments------------ -1---- ----- Size ----------------- ------Liquid depth -------------------------- Capacity------------------� r ' Id: Distance from: nearest well --- 677P_---- Distance from foundation___ Q---- rDistance to nearest lot line -.--,I .----.. - Number of lines_________ __.___ ___ Len th of each line____ _ --5S Width of trench__.`___ '; -- ---- 7 --------------------- Type of filter material___Sr_ Depth of filter material -___. ---------Total length_____-�`---------------- p Distance to nearest well___ .. ___________________Distance from foundation____..____ -__-__-.Distance to nearest lot line ----------------- ag -� Number of pits ---------------------- Lining material -----------------------Size: Diameter ---------------------Depth--------------------- ---- -----• !r4 Cesspool: Distance from nearest well________________Distance from foundation ___---------------- Lining material_._"______________._____---______- °\1 Size: Diameter -------------------------------------- Depth ------------------------------------------------- Liquid Capacity gals. l ❑ Distance from nearest building ------- ------------------------------ Privy: Distance from nearest well___________________________ -------------------------- ❑ Distance to nearest lot line ___-------------------------------------------- •- ------------------ - --------------- i Remodeling and/or repairing describe): ------ ----------------------------------------- ----------- --------------- ---------------------------------- qCounty I hereby cerci that I have prepared this application and that the work will be done in .accordance with San Joaquin ordinances, Stat la , and rules and regulations of the San Joaquin Local Health District. __(Owner and/or Contractor] (Signed)----- - - -- - ------------------------------e- '-------------------- By:--------(Title)--- ---- - ------------------------------------•----------------------------- (Plot plan, showing size of lot, location of system i�tion to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY {-------------- -------- D,ATE------- 3__ � 0:77 p --Q----------- ----- APPLICATION ACCEPTED BY____._ ---------- ------------------ REVIEWED BY ---------------- ------------------------- ------ ------------------------- -------------- --------------------------- DAT BUILDINGPERMIT ISSUED -------------------------------------------------------------- --------------------------------- DATE ------------ Alterations and/or recommendations: --------------------- ------------------------------------ ----- HNA` INSPECTION ------- ----------------- Date-�-- --''S------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street arae California Stockton, California Lodi, California Manteca, California Y. ES -9-2M Revised $-'59 F.9 -co.