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s-. APPLICATION FOR SANITATION PERMIT Permit No. / (Complete in Duplicate) 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. 549. ---------------------------------------------------------------------------------- ------- OCATION ------------ ------- ------ 44 JOB ADDRESS AND IY Phone--------------- ------------------- ---- - --------- -------- --------- - -------------------------- L ----------- ------------ - --- ---------- Owner's Name -------- /7 -- Address ---- ----- -------------------- _------------------------------------------------------ ------------------------------------------------- Contractor's Name - ............. Z1 4 -- -------------------------- 7 -------- ------------------------------,--------------- Phone ------------------ ------- e---- j Installation will serve: - Residence g Apartment Hou5e ❑ Commercial L] Trailer Court [] Motel [I Other ❑ Number of living units: Nulmbe,�of bedroom, :��- Number of baths I---- Lot' size -------------- ----------- .� Water Supply: Public system [Community system --fem El Rrivafe 0' Depth to Wafer Table ft.' Loam Clay Loam E] Clay E] Adobe 2/Hardpa'n'o Character of soil to a depth'6f 3'feet:` Sand.[] Gravei F❑ -1 Sandy Loim Previous Application Made: Yes F1 No N,New Construction Yes U? -No Ej FHA/VA-.Yes Ej No C] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if publjc sewer is available within 200 feet.) + Mt rial - ----- ---------------- ------- _76_�� Septic T k- Distance from nearest well_(PAV --------- Distan from -foundation ----- A5� 7 2- -.'3-'-Liquid clep��--___VT --------------Capacity------ ---- -------- ( No.. of compartments ------- - ------- a� ze ----- ----- Di . stance from n �stan nearest lot lin6_57-1 DisposalE* Id earesf we .... D ce from �founclafion ---- �0 --------- Distance to S' h of each I!* S.'2 r,_1PW' idtb of trench Z9 ------------------------ Number of lines______--_ — ----------- "I'length ---- J J!rQ--------------------••-----00 Type of filter mate ... 'Pth of filter material ----- --- i --Tota - 0. nearest lot line ----------------- -- o- - - ----------- istaric Seepa❑ge Pit: Distance to nearest well.------- e from foundati6n-- Distance. -------------- 00 Number of 1p�ifs ------- 1 - Lining �naterial ---------------------- Size: Diameter_ ----•-------------- Depth------------------ ' Cesspool: epth------------------cesspool.. + Distance' from nearest well ------------------ Distance from foundation ------------------- rLining material____.________.___------------- als. ❑ Size: aterial---------------------------------Size: Diameter----..._.-`-------- ---- �t ------------ w -Depth---------- -------------------------------------------- Liquid Capacity---------------- ------------ gals- FM�Distance from nearest weli ---------------- - ------------------------------- 'Distance from nearest building------_-------------------_ -------------- Privy: Distance to nearest lot line_:*------------- --- ------------------- ----- ------------------------------- --------------------------------------------------- ------------------------- — ------------- I ------------- --------- ---------- Remo'delirig and/or repairing (clascri�e):_ - ---------- : ------ ------------------- ------------- ----------- I -------------- ---------- - ------------ 4 ------------------------------------------ - ------------------- ------------------- ------------------ ------------------------------------ ----- ------------- -------------------------- - ------------------------- -------------- -------------------- ------------------------------------------ ----------- ------------------------------ ------ ------------------------------ --------------- - ---------------------------------------------- ------------------- ------------------------------------ I ----------- : ----------------- ------ - - - ---- ---- --------- I __ hereby - - - __ certify - - __ that - - __ 1 -1 have __ prepared I - - __ t . his - applicition and that . +he work will be done in accordance with San Joaquin County of the San Joaquin Local Health District. ordinances, State laws, and rules an r ul . ions 0 � I.--, e - L -- ---- ------ ------- --------------- - 1-t -------------- ----------------------- (Owner and/or Contractor) L__2---- (Signetl `� - ------- Y__ 4—(Title)--------------------- ------------------------------------------ By ------------------------ ----------------- By: ---------------------------------------- -------------------- -------------------------------- - ---------------------- ------------ (plot plan, showing size of lot; location of system in relation to'wells, buildings, e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ --------------- ---- ---------------- -DATE------ DATE------ -------------------------- 12 ----------------- ------------------------ DATE ---------------- REVIEWED BY --------------- I ----------------------------- ---- - DATE_____- vc BUILDINGPERMIT ISSUED ---------------------- I --- ---- --- --------- - -------------------------------------- __1 ---------------------------------- --- 4 --------------- ------------------- -------------- ---------- d Alterations Lnd/or recommendations:------ --- -- ------------ ----------- --------- e-Y A ------ ef.!A, 10 -------------------- ---------- ---- -------------------- 9,41 NAL INSPECTION B�: --- - -- -- -- -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street- 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Calif Manteca, California Tracy, California ES --9-2M Raviseo 1.57 EP CO.