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b`47) . APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 / Date 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 Ordinance No , JOB ADDRESS. , D LOCATION_____-___ ---------------------------------------•---- ------ Owner's Name x --•--------------------------------------------------------------- ----- -------------- Phone------------------------------------ Address-------------------- -------------------•------------•--Address-----------------•-- ••- ----------------_ ------------------: ----- r. ---------------------------------------------------- --- Contractor's Name------- •------ 0 _j lti Phone c,�� r f Installation will serve: Residence Apartment House ❑- Commercial E] Trailer Court E] Motel [IOther El Number of living units: - ----- Number of bedrooms __ ____ Number of baths __IJ____ Lot size Water Supply: Public system [E�Community system ❑ Private ❑ Depth to Water Table 4ai ft: Character of soil to a depth of 3 feet:' Sand Gravel ❑ Sandy Loam [) Clay am ElClay ElAdobe Hdrdpan E]E Previous Application Made: Yes E] No New Construction: Yes ❑ No A/VA: Yes ❑ No ❑ 1 TYP F INSTALLATION AND 4ECIF1CATIONS: 1j {No septic tank or'cesspool permitted if public sewer is available within 200 feet.) epti Distance from nearest wef}_________________Distance from foundation_____._______--__-.Material--.-_-______._._______.________-----___._- No. of compartments-------------------- -----Size--------------------------------Liquid depth--------- -----------------Capacity----------------- sa Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_______..______. I Number of fines_________________________________ Length of each line------------------------------Width of trench._____._-__________._ ------------ ' Type of filter material-------------------------Depth of Iter material-----------------------Total length----------------------..---------Q- .. �1 Seepage : Distance to nearest well_;_ _ Distanc m oundation__ ____--_-_-. stance to nearest lot line -_- ____ \ Number of, its`_-- Size: Diameter_-- ---- Depth---�.- ------------- p �---------------Lining material-- ----------- _ Cesspool: Distance from earest well---------------_Distance from foundation--------------------Lining material___________________ ❑ + Size: Diameter= - `Depth------------------- ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance froma:nearest well----------------------------- ----------Distance from nearest building L] Distanceta'nearest lot line-----_---------------------- ------ -------------------------------- = E , Remodelingand/or repairing (describe): - -------------------------- -------------------------------- --------------------.--------------.----------------------------------------- i ------------------•-----------------•------•--------------------------------------------------------=-------•---------------------------•----------------•-----------------------------------------------------------•----- --------------------------------------------••------------ ----------------------•-------------------------------------- -------------------------------------------------------------•---------------------------------•-------------------------------------------------------------------------------------------------------------•-------------- I hereby certify that I have prepared this application and that the work wil one in accordance with San Joaquin County ordinances, St laws, and rul�sn_d re ulatio o the San Joa uin cal a Distric� /[Signed}---------------------=-- � A - ------ ----- �. �t^ - C � `(� Contractor) !" ►� lf� f Y� (Title) E (Plot plan, showing size of lot, location of system in.rel Eon to wells, buildings, tc., can be plat on reverse side). - E ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------- DATE------,; .'._----•-•-------•-------•----------------------• ; REVIEWEDBY---------------------------------------------------------- ------- ------------------------------------------------------ DATE-------- BUILDING PERMIT ISSUED._...... €------------------- ------ ------------------ DATE.---- $ Alterations and/or recommendations___________ __________ ___ _ ---------------- ----- ------------- -------------------------- -f - - {r is,__ 1a_ .. ------------------ b___ ----------------- ---------------------------- - tV� - ----------------- •---------------------------- ---------------- --- ---------------------j----------------- •--------------------------------------------------------------------------- FINAL INSPECTICfl BY:.. =.`: -------------------------------------- Date-------_a '` _ 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mantoca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.