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APPLICATION FOR SANITATION PERMIT Permit No. - >� (Complete in Duplicate) . Date Issued ___._ _3�j5--�- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinanc o 549 67da JOB ADDRESS AND OC ON_____ ____ }� 3., -------------------- ------- Owners Name.---- __ -- - - - ------------------------- Phone------------------------------------ r Address---------- •--- --- - -- ----- ------------------------------- e --- -----------{---- ------------ Phone _ ,4`7 Contractor's Name---------------------------- Installation will serve: Residence ® -Apartment-House-0- Commercial{❑ Trailer Court ❑ Motel ❑ Other ❑ Number of bedroomsc5 -_ Number of.baths _ /_- Lot size ------ - ---fQ ------------ Number of living units: k Water Supply: Public system Community system" Private F] Del to Water Table '0ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑" Sandy Lamy El Clay Loam E] Clay E] Adobe[ ardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes Ell, No j--'VAA/VA: Yes ❑ No TYPE OF-INSTALLATION AND SPECIFICATIONS: #� v (No septic tank or cesspool permitted if public sewer is'available within 200 feet.) tip , k: . Distance from nearest well-_--________---_Distance from foundation____--______`.___--Material___________ No. of compartments--------------------------Size--------------=---=-•-=l-------Liquid depth--------------------------Capacity-------- - -:------- ds a Distance from nearest well------------------Distance from foundation----------__1..----Distance to nearest lot line_____-______...__ Number of lines-----=-----------------------------Length-of each line-------------------`--------Width of trench----------------------------------- (j Type of filter material------------- --=------Depth of filter material-------------1---- ---Total length--------------------------------•------ f 11 � 4 f, _Disten e m fo dation__ Q_.____ t ch to nearest lot licn--e�__ _ -__. Seepage P Distance to nearest weil __-_ -- Depth "Ws.? __Linin material_ Size: Diameter__. -_----_- . Number of pits___-------- -- 9 � ol: D-++stance from nearest well_________________Distance from.foundation---------__..._--_.Lining material--.----------------------------------- essp El Size: Diameter---------------------------------------Depth.---±--=-------------------------------------------Liquid Capacity----------------------------gals' F Privy: Distance from nearest well--.-------------------"------------------------- Distance from'nearest building- ---------------------•----- ❑ Distance to nearest lot line----------------- ;---------- -------------------------------------•- ------------------------------------------------"---------------' = ` - --------------------------__----------_________________________________________________________ Remodeling and/or repairing (describe):_____--_------------------•----- ---`-- _-___________ ----------- ---------------------------------------------------- ---------------------- --------------------------------•-----------:-----•------------ ----------------------- ------------------------------------------------------------------------ I here certif that Iphavrepared this application and at the work will be done in accordance with San Joaquin Coun+y Yordinance t e la ndnd regulatio of the San quin Local H District. an / r Contractorer d(Signed)•--- �--- ---- ---------- ----- -- -- -------- --------- ----- --------------' -----(Title)------- � f Plot plan, showing size of lot, location o system in relation f well uildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY .. DATE----- APPLICATION ACCEPTED BY ��® - �'`* ---------- REVIEWED BY------------------ ---------- DATE----------- -5------------------- ----•- BUILDINGPERMIT ISSUED---------------------------------------- ----•-----•----------- ------------------------ Alterations and/or recommendations:-----------------------a ----------- ------•-----•--------- I 60- ------------------------------------------------------ ------------ ------ - -- - ----------- ------------------------------------------ ----- Date_ `� ----------------------------------- � � ""'. �}------- - ---1=INAL INSPECTION BY:----- ---�------ ----------•---- -t SAN JOAQUIN LOCAL HEALTH DISTRICT !32 S camore Street 814 North "C" Street !1 130 South American Street 30o West Oak Street Y �: TCalifornia Stockton, California Lodi, California Manteca, California Tracy, t ES-9-2M , Revised 1-57 F-P.CO- + '^