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1 APPLICATION 'Fd R SANITATION PERMITPermit No __� . _,�--____ (Complete in Duplicate) U Date Issued Application is hereby made to the San Joaquin Local Health-District for a permit to construct and install the wo herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION q---1 - -- -------- ---------------------------------------------- I---.--r ---------------A------ Owner's Name__ ------ - ----------------------------------------=--------------------------- ---.-- P hone_ 'T Address---------- - --`---I--- .. •--------------------- ---------------------------------------- -------------------------------------------------------------------- •---_---_ 1/ „ �, l Contractor's Name = "� '� "--- -------------=---- - ------ Phone----------: [ p Cbmme tial'' ❑" Trailer(Gourt ❑ Motel Other a Installation will serve: Residence Apartment Houses - k' P. r�� Number of living units: 1 Number of bedrooms __ Num��Depfh baths _�-_,1__ Lot size ___-l�- -�__ -�----� 1 Water Supply:: Publics stem Commuriit system Private to Water Table ___..___ ft.PP Y' Y ❑ Y Y ❑ I Character of�oi�deph_o 3'fee-r—Siad I]Gravel ❑Sandy Loam —CI —y Loam❑"Clay❑ Aolobe Vardiaan ❑ i llti is ti t ❑ No' New Construction: Yes No E] FHA/VA: Yes E] No ❑ Previous Application~Made:• Yes TYPE OF INS.T`ALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: , Distances;from nearest weil__� ____j_Distance from --------------------Material i.—No.of compartments---=--<_!- -------.�-,-,-,,--,.Size-------------------------------Liquid ce�th.. ------------------Capacity---------------f : Disposal'F,ieVl Distan e fr m nearest well_^cJ_0!!":_.Distance from founc{ation_It��f�Distance to nearest lot li e ,. I rr ❑ I tNamher of lines___________ ___ _ Length of each line------- Qc____ {t-_.Width of trench._____.Z±______I____ --- �J i Type offfiite'r�materi P --- g �De Depth of filter material___.______ Total length __ Seepage P:it: Dis#ance to nearest well----------------------Distance from foundation------- -_Distance to.nearest lot line----------------- _SiDiameter--. ze: --------------------- ❑ Number of pits------ ---�--------------Lining material.--------------------- Depth-------- - ----'----------- Distance ---- • -- Cesspool:r � �Disea�n..�ce from nearest well-----------------Distance from foundation.._.______________Lining material--------------------.-___ _-____-__.- ❑ A a t iS�ze:f:Uiameter------- N -----Depth---------------------------------- -----------------Liquid Capacity-------------4--------------gals. Privy: Iff lDistance from nearest well-------------------------------------------------Distance from nearest building---------------------------------_-=----.� ❑ -Distance to nearest lot linel-------------------`-------------------------------=--------------- ----------------------------------------------- ------ Remo in and' or epairing (, escrib -!�-�-------- ------1 . '... �� ;� r ---•-----------•----------------------------r '._A_----------= - r_'P"�--- �� = a ------- -•-- ----- ---- -- --- --- --------------w--- -------- ---- -------- _= -------- ------------------- ----------------------- f ( --- - --------- I hereby certify that I have re ared4his application and that te work we done in accordance with San Joa uin County I Y f Y hP P PP hhkill bdi q ordinances, State laws, and rule -and regulations of the San Joaquin Local Health District. (Signed)---------- ---------------- -------- --------------------(Owner and/or Contractor) By�--•----------------------------• --- --------------------------------------------- ---------------------------------------------(Title)--------------------------------------------------------------- (Plot .plan, showing size of lot,Wation of system iri.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------- DATE��----------------------------------------------------- JyREVIEWEDBY -------- ----------; --------------------- .:_.. DATE. - -------------------------------------------------- I `BUILDING PERMIT.ISSUED----------------------------------------------------------------------------------------------------- DATE-------- ----•-------------------•------•-----•----- Alterationsand/or recommendations---------=------------------- ---------------- -------------------------•-----------------------•--•------------------------------------------------------------ ' -------•------------------•- ---------------------------------------------------------------------------------------•------------------------- ------------------------------------------------------------------•---------- --------------------------------------------------------7-------------•-------------------------------- ---------------------------------------------- --------------------------------- -----------------__---............ FINAL INSPECTION• BY:--------------------------------------------= Date-------- ------------------------------ I SAN JOAQUIN LOCAL HEALTH 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-9-2M Revises 1.57,F,P.CO. J