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r P APPLICATION FOR SANITATION PERMIT No. {Complete in Duplicate} / ` Date Issued _____ _-- -- Application is hereby made to the San Joaquin Local Health District for a permit to cons+ruct and install the work herein described. This application is made in compliance with County Or •.nance N4.9. he�JOB ADDRESS AND ATION--- 51 L = ------------------------------------------------------ Phone } C Owner's-Name_ ----_ r 1.:1 - 4 ' ' ------------------------ Phone Address_'. == l -- ----- -------------------------- ------------------------------- -----------------•--------------•------------------------ _" t ------- ----- Phone----------------------------------- Con+ractor s Name-- = =T -- - ----- �------ ---------- i Installation will serve: ----------- Residence Apartme �t'(ou e C mmerci ❑ Trailer Court 454—'Motel Other ❑ i I Number of living units'=* .__ um'�er.,a e r�oloxrrirs`_ _ _�,_i um abaths ______:_ Lit„size `-- -. ---- ' s Water Supply Public system ❑ CFominunity�syste"mr�Private-{ Depth to Water Table -------- ft. f Characterkof soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan F] Previous Applica+Eon Made: Ybss No 0 New. Construction:a,�Yes ❑ No FHA/VA: Yes El No m E TYPE OF1`NSTALLAilOtN AND-,SPECIFICATIONS: ! i"(No septic tank "cesspoolermi+ted if public sewer is available within 200 feet.) ep is Ta k: 1. Dist duce from nearest well__!_____________Distance from foundation___ _____.,__---Material__-_----_________________---____________________- .r .. No. of compartmen0__?---�---�-------------Size-------------^ Liquid depth:____ Capacity i I F x 1 t x Number of lines----rest we'l----�------------- •g. e- } ation---+.----------- ---------- --:Distance to nearest lot line---------------•- 1 t---.Width of french----------------------------------- i Dis{aosai"Fieid: Distance from nearest well_._._ Distance•-from-fours I -------------- -- E i 1 ten th f each line p Type�or filter material s._r__ _____ Depth of filter material---.__',_____�_.=_,_Total length_________________________________(-_-__. 1 5 page Pitt l DEs#ance to nearest ell___l- -__Distance fpundation--_1Q__:�__.D" tance�to nearest lot lir{e____ ___________ Linin material Size: Diameter/Q. Depth_.__ Number of pits------ g Cesspodl: Distince from nearest well-----------------Distance from foundation--------------- ___.Lining material-----.------------------------------- X. Size Diameter _`---------------- —:.rc_--Depths_---___: :=— - -------------Liquid Capacity----------:-----------------gals. Privy: Distance from nearest well--------------------E------.t-------------------Dis`ante;from nearest building----------------------------------------- Distance to nearest lot line------------------- --- -------------=-------•- ---------=------- -- ---------------------------- --------------------- 171 i f , E l ---- -------- �Z -- ------- Remodeling and repairing [describe):_ r� ys�►L R l l s k M _ ---- ------------------- -- ------ BB [ , 5 i I hereby certify the+ I have prepared this application and that the-work will be'done in accordance with San Joaquin County l ordinances, State laws, and rules and,regulations-bf the San Joaquin Local Health Distric+: i E f I � -- ------------- -------;------------ ----------- ---------`----------- ------ -(OWne and/or COntrdG+Or} (Signed)---------- - _ �.a B 1 -------,`------------------ (TitleJ__._!P ltL - y - �. l (Plot plan, showing si a of lot, location of system in relation to wells, buildings,letc., can be placeev seAside). i t 1 FOR DEOARTMENT USE ONLY � DATE-----I - APPLICATION ACCEPTED BY------_-------- # - _ '� {:� REVIEWED BY ; -- ------------------ -------- -- ------------------------ DATE --- BUILDING PERMIT 155UED= = _ l:_ = Y DATE r ° --_--_- - ” -- -- ' ' l r --------- -------- - Alterations and/or recommendations: --------=---- -------------- q ---------------------------------------------- ------ ---------------------- ------------------- ---- ---------------- , Y ---------------------------------------------------------------------- -----•---• --•------''---------------------•----------------- ---------•----------------------- ---------------------•------ ---------------- ----------------- ---------------------- Date_-_. �J C�-s- FINAL INSPECTION --------------------------------------------- - s SAN JOAQIJ - ,; _6 ,'RICT a �N LOCAL HEA TH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revises "1-57 F.P.CO.