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�l 1 ,9 . -� � APPLICATION FOR SANITATION PERMIT Permit No. ___ _____ ____ ., �., (Complete in Duplicate) S Da+e Issued'____.________ 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 dinance No. 549. s JOB ADDRESS,A LO TION - '- - --- i---- `�� j' ------------------------------------------------------------- Phone--------------- ----------•- ' Owner's Name-- --- ----- ---- ----- - ------- -- ------- Address �� ` C �n ------------ -.. -- Contractor's Name �( -- Phone.---•------•--------•---•---------- --- ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot?l ❑ rOther Number of baths I----- Lot size -- x c T� Number of living units: J,/Number of bedrooms _ f Publics system system ❑ Private ❑ Depth to Water Table __-"_--_ ft:� .Y Water Supply Y ' Character of sol! to a depth of 3`feet: , Sand Gravel ❑ Sandy Lo�PNo Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ Previous Application Made:-Yes ❑- No New Construction: Yes ❑ FHA/VA: Yes ❑ No Prev pp f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public s wer is available within 200 feet) � rl at - I- ------------- P, �. Dista cep from foundation___ _ Septic ank: Distance from nearest weII��I/___ __ _ r1, ------- Sep uid pth---- -- ------- Capacity No. of compartments--___-- _-- q s� r I �_0 /f 'U'.fance-to nearest lot lin �I distance from foundation____ ______ _____ . �1_`7�tc�►✓ Dispos ieid: Distance from nearest well.__ _� en th of each line----------=----- Width of trench.-------2-------r------------ Number of lines---------- - --- -- -------- - 9 t,J-------- 1-2149 Type of filter mater _ _ _tpth of filter mate Total length------------- __________-____ f a weepage Pit: Distance to nearest well ________----Distance from foundation____________________Distance to nearest lot line__.___,_________� 1 ' Number of its --:Lining material------ --------------size: Diameter Depth Cesspool: Distance from nearest well------------- ---Distance from foundation--------------------Lining material-------------------------------------- Size: Diameter_--=-------------------------- ------Depth----------------•-----------------------------------Liquid Capacity gals, ❑ m _Distance from nearest buildin Privy: Distance from neares# well -------------- -- -- 9 -. ❑ 4 Distance to;}nearast lot line t Re ode or re airin crit "" g } ` , ----------------------- --------------------------•-------------------------------•-----------•----------•-------------------------------------------. ` � -" --------------------- --------- ____ _ __________________________________________________________________________________________________________________________________________ �. I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws-And rules andZregtions of the an Joaquin Local Health District. -_____.__ (Owner and/or Contract orl [Signed).._____ _ ---------------- Title o --- --- ------ (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 f APPLICATIONACCEPTED BY-- - ------- --------------------------------------------------- DATE----- -----------------------------------•---------------- - REVIEWED-BY-------------------------------- ---- ----- ------- ---------------_---------------------------------=-------------- DATE PERMIT ISSUED----- ------- DATE.. Alterations and/or recommendations--------------------------------------------•------------------•---------------------------------------- _-____.____»_______- ---- ------- ---------------- - ------------------------------.--"""-_ -i"__.._.-- �-�� -7 FINAL INSPECTION BY--= ------ -- ------ - - . Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street f30 South American Street u Tree California Stockton, California Lodi, California Manteca, California y ES-9-2M . Revised 1.57 F.P.CO.