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_ _ F R OFFICE USE: h / .......APPLICATION FOR'SANITATIONNo. . �_ �_�.- -c 4r--�— -- - Complete in Du heats `� 4 "` _ { P Pi }': Date Issued -- --_ . . ____ _ - -------------- u` ' This Permit Eigires 1 Year'from Date Issued Application is hereby made.to'the San Joaquin Local Health District for a permit to c struct and install the work herein des rbed. This application is made in compliance with County Ordin ce No. 549 ,AQDRESS ANOATJOB ON ............. ' Owner's Na ._. ------ - ------- J Address % v '- 1 ` _.__.... Phon ..... } �. r � Contractor's Name..__ - .�'=- ••- F - ---- v l Installation will serve: Residence rtment House [3 Commercial E] Trai er Court [I Motel :❑ ther ❑ . 5 ......J__`3...------------- i Number of living units: __ ___ Number of bedrooms Number of baths __/___ Lot size Water Supply: Public system • Immunity system-.El Private,❑ Depth to Water Tablef#. 3 � � � Character of sail to a depth of 3 feet: Sand E] Gravel E]- Sand Loam E] Clay Loam I] CIV 0 Adobe gj- + ridpan ❑ Previous Application Made: (If yes,date-----------_--------) No New Construction: Yes No.❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 i. (No septic tank or cesspool permitted if public sewer is available within.x00 feet.) p eptic Tank: Distance.from nearest well-----------------Distance from foundation............____Materiel--..._-_______-__.________........+.............. ;11 No:of compartments--------------------------Size--------------------------------Liquid depth- t Capacity €.' Disposal ield: Distance from nearest well___--_---------Distance from foundation....................Distance to nearest lot line_.J.__.......... t , 51 �, Number of-lines---------------.-------------------Length of each line-------•-------.._..--------;.Width of trench-----------......•---'----...----_-- / Type of filter material_____________________-__Depth of filter material___-__-_______--_____Total, length_________._..I...............------_----- Seepag Pit: Distance-to-nearest-well-_,1 _Distance fro�n7f ndationZ'_ "'.Distal ie to nearest lot line., ....... st Number of pits-----__ _ __ g mateiiaL "' .�_ Sixe: Diameter._- __...._.Depth___ _ ___________________ r Linin -��s Cesspool- Distance from+nearest well-----------------Distance from foundation--------------------Lining material--------------------.._,......_-____. ❑ Size: Diameter-------- •-----------------Depth------...--------------•--------•--------•------:---Liquid Capacity-----... ---------• gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------...._________--_---___;__-------- ❑ ' Distance to nearest lot line--------------------------------- ------------- ----------------------•---------•----•--•------------------------•--•--=-----•------- Remodeling and/or repairin di6e):_ �.�"_ - -----------------•--•--•-- ------------------------------------------------------------------ -------------------------------------------------------- / "� j' r ------•-------------------••-- ---- -----�----- ... - I hereby certify-that I have prepared this applicationnd that t e work will be done in accordance with San Joaquin County ordinances, State laws'-end-rules Ssnd egulations of the an�Joaq n!Local Health District. (Signed}. ---- - - ----------- -- -----(Owns sand/or Contractor) ( / V BY� r'' - - ------ ----•------------------------ (Title €'.,re f + Plo+. Ian, �h c�,•i f lot, lo -ff -of system in relation to wells, buildings, etc., can be placed on revs a side). ( P � ! FOR DEPARTMENT USE ONLY APPLICATION.ACCI PTSD BY. -----._-- DATE �- �� - -------•---- REVIEWEDBY�``-`----~---------------------------- ---- -----------------------=--------------------------•------------ DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------•------------------- DATE-------------------------._--------------------------------- f AFFeret'sons and/or reco "mendations: :.•------------------------- - l -- ` --------------•---- ------•-••-•- •- , � -------- I -- . •------------- -----------------•-•--='='=--••-----------••------•-•-----------•-------••------- •------------• :__ r . ----------------1 1. I ' r '1'` --- -------- _/1.--J_6---�`-- ------------•---------------- Date---- -�--�-�,`- 1' ` .... FINAL INSPECTION BY:----- ............:....:. . � , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED 8.69 ZM 6•6t ATLAS