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�2— h�l a APPLICATION FOR SANITATION PERMIT Permit No. :__.`................. (Complete in Duplicate) TI-)0/'� 4 Date Issued ----------- A ---------- f y s a work herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the k e This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-__, ' l (/ 1� --/ � Owner's Name ,. - ---------- Phone-----------------•------------• --- ` .... Address=----------------- lam -- - :----- ---------------------- Contractor's Name-- �I� one Ph Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Je Number of living units. J__-_ Number•of bedrooms _L_-_ Number of baths ___/_ Lot size ... f.J_ - - ----------------------------- Water _________________________Water Supply: Public,system P�ommun'ity system ❑ Private ❑ Depth to Water Table_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' rdpan ❑ Previous Application Mader Yes ❑ No P New Construction: Yes E] No gp--_�HA/VA: Yes ❑ No 94-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) p y ---------------Liquid depth--------------------------.Capacity------------ -- ept' Tank: Distance from nearest well_________________Distance from foundation________-_____-__..Material____.____-------------------------- � No. of compartments ?---------- jDisp �I Field: Distance from nearest well_______________ _ Distance from foundation----.__._�_ ____,Distance to nearest lot Gr<�_____.________ Number of lines-------/___________."--Length of each line___��^__�Q__.Width of french______��_____________________ T e of filter material __ De th of filter material_ Total len th____ yp i/ p f = g I Seepage Pit: Distance to nearest well__"' --Distance from fo dation___'.!A0-•---...Distance to nearest•lot line--------- i --r Number of pits.___. �-_':.___Lining mate ria 1,ol,:6 __ Size: Diamete'r,„&�----___-____Depth-------,__.0__-1------------ Cesspool: Distance from nearest well----- from foundation--------------------Lining material-__ ___-____--------____.____________- ❑ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity-. ------------------------gals. a 1. Privy: Distance from nearest well---------------- ----Distance from nearest building .________________.'.________ . \ ' . . .. Distance to nearest lot line-_.------------------------- -- ---------------------------------I-------------------------- --.----------------------------------------- v Remodeling and/or repairing (describe}----------------4e ---------__-`- -- _ ------------------------------------ } ---* -. i ------------------------------ -----------------------------•-------------•---•-•--------- --------------------------------------------- ------------• ------------------------------------------------- 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 and regul hions of the San Joaquin Local Health District. Si ned Y F .. � � r ( 9 } '" `�' -------------------- Contractor) BY: = ----- -- - (Title} �� (Plot plan, showing size of lot, locign of system in relation to wells, buildings, etc., can be placed on reverse de). FOR DEPARTMENT USE ONLY kAPPLICATION ACCEPTED BY------------- --------- --------------------------------------•- --------•---• DATE __--------------- -----------------•-------------- REVIEWEDBY-------------`--------=--•---------------- -_-------- -- ------ ------------------------------------------------- DATE �J \ -------: -------•-----------•------ BUILDING PERMIT ISSUED__°__:__..._.. - DATE.. -- -------- BUILDING and/or recommendations:_____--._________ ___ _____ f ----------------------------•------------------------------------------------------ •-- - ---- ------• •-----------• ----------------•------•------------------------------ ------ r -R----------- 1 __________________________________________________ __________ ��___-_��- _ - _______ _____ _ _ _ __ __ _ __ -----------_--------------------------------------- _____________________________________ ----------------- -:•�/--_ _____________-_-_.-__ L- -R_ _ _ 4 -l_ _ ____________ ._.-_______ __ _ _ _______________________________.______...____-___.__.__-___._---________.___ _._-_--__-____._.._______________--_--________- _ .__---___________..______..___--_______-_________._______.___________ t s --"" "' Date------ FINAL INSPECTION BY: ' = = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Sfreef 814 Norf6 "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 ES-9-2M Revised 1-57 F.P.CO.