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APPLICATION FOR SANITATION PERMIT Permit No. 6 S._.3 3 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin~local Health District for a permit to construct Ad install the work herein described. This application is made in compliance.with County Ordinance"No~S49. --- -j 1 t JOB ADDRESS AND LOCATIO_ - __ -- l-- _- -- t �/ �. ` ,� j/� LL`, 1 q Ph Owner's Name 1 :if '" ! 1- ' �[ one, 9 _ 7� `Z - ---------------- -------------- ---------........... X0 < � ------------- • ---------c-. v ------�-/---�- --- t ��- �: , ' �- : �,> ��,�.r-._.� •�-' hone----`---- -----------•--------- -'"1 ' -� - ------- - P - f,:_-------- Contractor's Name________________ _ ----•--- J Installatiori'will-;e'ry Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q` Other ❑ Number of living-•un1its:�__ ___=Number of bedrooms___ Number of baths ---(_- Lot size _ _ ______________`----•---------- Water'Supply: Public system .� Community'system ❑ Private ❑' Depth to Water Tablet/4 Character of sail to a depth of .3 feet: Sand ❑ Gravel ❑:. Sandy-Loam ❑- Clay Loam El Clay El Adobe(� Hardpan ❑ e . . Previous Application Made: Yes ElNo [�,�New Construction,' Y-`s❑ No [ FHA/VA: Y.es f-] No TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or' ool permitted if.public sewerais available w thin 200 feet.) �.. _ l' I �Q V-1. Septic T k: , stance from nearest well- Distance f om.fou,dafion_�'>� No.'of compartments-------- � a ..Liquid deptCa acitSizeP y---� . , / Disposal Field: Distance from nearest well.____ 'rU_-Distance from foundation__=l�___r_____Distance to nearest lots ne_____.___-_•.___ -� ----Len tli of, each line - fF- Width of trench--- - Number of-lines_-_____1 9 Type of filter material__ _ 'Depth of filter material:_.__-I ------Total engohnearest lot i - ' PDistance to nearest rwell____ ________ ____Distance fgo i f�_;ndatio __ __..-_eistan� l r NumUer of pits-------f -_-.-------Linin material_:_ -� :;Size: Diameter_ ------.Depth----- ---------- it: " . n Ces pool: Distance from. nearest well_________________Distance from foun ----------------- _.lining materia!__.-_____._._-_--______.___._____-___ ❑ Size-Diameter-------"--------- ---------------------Depth-------------= _ ------ -------------- 'Liquid Capacity.. gals. -- Privy': 1.. Distance from nearest well cw; = ' "` "_ ------Distance from�nearest'b'uildin ❑, F r. ------------- ----------------- --------- 'Distance to nearest lot line -- ---------=------------------ 1 .. ------- ---- -----------------------•--' I Remo ing and�or rep r' (des the _--....Z e -- t4� --------- �- - ---------------------------------------- ' ----------------------- ='- ---------------------------- ---- - -- - -----...---- ------•------------------------ i I.hereby certify that I.have prepared this application and�that;the work will be dpne in accordance with San Joa9 uin County ordinances, State laws, and rules and regulations of the San Joaquin•Local Health District. ! ----------------------- = (Owner an ,Contractor) (Signed)----" ---------------•-------------- • . : (rit } gY•-------------------------•- a----------------------- (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 [ APPLICATION ACCEPTED,BY. �" - "= - -- = — ,_,-DATE-------- ----- -�---4--------- ------------- -=-. DATES = ---------------------- REVIEWEDBY------------------------- ------ : --------------------- ----------------------- BUILDING PERMIT ISSUED--------------- --------- ------- ---------- --------------------------- DATE Alterations and/or recommendations:`--------- ----- ----._ ----•--------•--------------•-•---------------------.-----------; _... l _ -- ----- ----- ----------------------------- ,- ---- . ---------- ------------------------ ------------------------------------------------------------- F FINAL INSPECTION- BYDate----- `� --'-=-- -- ----------------------------------- --- :.:'=--- --- -----••--------- ------------- -------------- - - 77 SAN JOAQUIN LOCAL-HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California Stockton, California . ES--9-2M , Revised 1.57 F.P CO-