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&c.% I\j 0 .. - 7 k , ADPL#CATION FOR SANITATION PER Permit No. __,._ T ---------- i 1-4 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliancg7with/ oVy inan 549. cP dv 10 JOB ADDRESS AND LOCATION------- ______ _________ d ~10 ---------- Owner's Name-------•---• — .�l l.T`C, A ir - ------------- - - _ _ -- ,� --. Phone---�-------------Address � ' i-- -----••--- -- _e .... - - ----------- -------- 1 .r C'ontractor's Name-----_-------- "F` 1�r ---------}-------------- ---- -- -- - -- Phone _ _ a Instaliation will serve: -Residence [Apartment House ❑ �Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: _ � Number of bedrooms Number of baths ___1___ Lot size ----- ............ //-S( -._---- #1k Iy y y ❑ .Private ❑ Depth to Water Table ___,___ ft: Water, Supply:',PublicYsystein 5?'-Co "system T Character of soil to a depth of 3 fee+: Sand.❑ Gravel .❑ Sandy Loam Clay Loam ❑• Clay ❑ Adobe Cr-Hardpan ❑ Previous Application Made:1Yes No �No ❑ FHA/VA: Yes [] No EZ.— I ❑ New Construction: Yes TYPE OF INSTALLATION,AND SPECIFICATIONS: (No septic.tank or`cesspool permitted if public sewer Is available within 200 feet.) Septic Tank: Distance from nearest well'-I1� __ Distance from foundation____a/_ _-_T.Material__ ---_-_.-- LG1fa 4 il _.. No._ofcompartments__________ _____.__ Size_. . . 5 ` 2.Liquid depth------------ C Capacity------ Disposal P Y g . a a t ____--p-- Disposal Field: . Distance from nearest we _ . _�N .Distance'from foundation____._ r '____Distance to nearest lot line---;4_---____.. t� pe of filter of Tines--------------- - --------Length Length of,each line------------ -Q_-__-----:Width of trench.---_----- - -�-� Tyf filter mateciai_ `�f UC_r ' Depth of filter material-____A,�_--_-______Total length_-______._.l -�_ Seepage Pifi; - Distance to nearest well_"__ :"-__''��Distance from foundation___________________.Distance to nearest lot line...... __..___.._ , ❑ x ._1 „ , ., Number of pits...- Lining material----==-----------------Size: Diameter----------------------=.Depth----- ' ' ---------- ❑p l: -_=•, Distance _from nearest,well.__-___.__`�_:Distance from foundation-------------------_Lining material---------- ------------ o Size: Diameter------------------------------ ------------ --'------:-' ----- Depth------------ =~ 1., a ------------- -----------------Liquid Capacity ...gals. z Privy: Distence,from nearest well-_:`.? _ ❑ -�-�-._�_•__-__.__�.�-_____2__L_�___:___ _______Distance from nearest building----- ---------Distance to'.nearest-lot line_______-- Remodeling and/or repairing describe)__ _ ' -- W - - t ------- .a ---------------------------------------------------------------------------------- --------------------------- - ---------- -------------------------------------------------------= --------------------•-----•- ------------t I 'll I"hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ti ordinance tate laws, and r nd regulaci s of the San Joaquin Local Health District. (Signed) -------- �t r ------------ --------------------------------- ( wner an r Con tactor BY - ------ "------- ry r` `' '----------------=-------(Title)------------------ -------------------------- - - (Plot plan, showin size of lot, location of system in.relat' o wells, buildings, etc., can be placed on reverse side). ; FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY--------------------- DATE I f € -- t' REVIEWED BY -------- ---------- -- - - ------------- ---------'--- - ------- -. DATE - ------'-- -- - �------ -------- __.... BUILDING PERMIT ISSUED------------------------ ------- -- -- -'-----------=----------------------------------------------------- DATE------- t -- - --------- Alterations and/or recommendations:________>_________ _____ _ ' -��----- -------------------------------------- ----------- •-•-•--•---------- ----------- ------ ---------- ---- ----•---------- -- FINAL INSPECTION-BY-------=--------------•------- 1=•:- ---------------------- Date-_ = - �s = --------------•------------•------ SAN JOA�UIN LOCAL HEALTH DISTRICT 130 South American Street 306 West Oak Sfraet 132 Sycamore Street 814 North "C" Street 'I Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M , Reviseq 1-57 F.P.CO. P +f—