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n ,(1115 APPLICATION FOR SANITATION PERMIT Perm ` V6, (Complete in Duplicate) Date Issued Application is hereby made tote San Joaquin 'Local Health District for a permit to construct and install the work herein described. This application is made in compliant with County Ordi ante No. 549. li -- . til- JOB ADDRESS A LOCATI N - - -�- 'Owner's Name------ � � ------ -------------- Phone--/uAP"- Address.------- -J3- .. I Contrac+or's Name a- - one Ph Installation will serve: Resident Apartment House J] Commercial Tra"I r Court ❑ ❑ ❑ Motel [� Othe Number of living units: _- ___ Number of bedroom�._ _,,Number of baths - Nit sixe�__Water Su I . Public s stem y y �1 p_ti`�x L` ��PPy' y ❑' Commun'it s stemate ❑ Depth to Water Table -------- ft. Character of soil to a depth of.3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [✓Hardpan ❑ Previous Application,Made:-Yes�E-1No•�New-'Construction. Yes,�o-E-,-FHA/VSA:-Yes-�Na-. , 1 , TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or:cesspool permitted if ublic se er is available within 200 feet.) 1 f2 Septic ank: Distance from nearest well Distance"from_foundati'c i f s. aterial- No. of cbmpart dents____-- . Sze_ . - _ ©__.S. Liquid dept I---------------- Capau�f ' n�' Y _ Dispos I Field:- Distance from nearest vfell_-_.__..? Dista'ncelrfr�rrn�•foundation__. __ �= istance to nearest lot line_ _ r_ Number of lines..--------- ----- - -----------=Le nth of each line------- i t �f r ! 9 _ Width of trench--------- ( ----- Type of filter mater epth of filter material__ ,f _ g - d T w ,4'�---Total length -------------f�--�-_-- - ,_ Seepa Pit: Distance to nearest well_____---- --___ __:Distance m fou ation-� Distance to nearest'lot line____ Number of pits-°1__-_�___---_-Lining material-__'_____ ____ _ ______ ' e: Diameter_'.__ . i IIc Depth----- 12.A--- -- t Cesspool: Distance from nearest well----____________Distanceys from foundation---------------------Lining material-_____._. _-_-- ❑ - Size: Diameter---) - ------------------ Depth---t------------- r' I { i -;y , Li�uid Capacity------- gals. Privy: Distance from nearest well________________7.__- :�-__-[---------------_Distance from nearest building__--______.__ _-_----___-__I--.--; ❑ - Distance fo nearest lot line--.__-_-_____________ -_ e1 ------------ �. , Y --------------------- ---- Remoc lin nd/or repairin4 (fcl scribe}---------------•----- --------------._ rt" ------------------------------------•-----------•--------------------•-----------------_. - fI prepared P P ; # t, I hereby certify that I have re ared this a lication and that the .work will be done in accordance with San Joa uin C Y y _ ill - -- -- - ------ - - - - z q ourity ordinances, State laws, and rules and regulations of the San�oaquin Local Health District. a i M (Signed) �. n - ( w -and/or a tractor) �. O ner By� = _..: -------------- . - - --------- ------ -- Title--- : (Plot plan, showing size of lot, location of system in relation t w{IIs, budingls�'etc., can be placed onnev�eride °" } y , a FOR DEPARTMENT USE ONLY - w APPLICATION ACCEPTED BY -----�-------- ----------- --- -------- ------------------ DATA�- ------------- BUILDING . ; BUILDING PERMIT ISSUED---------- _________ ________________ __ _ �_____ ___ _____j_---- - DATE = ----�---- ----- f-I----------- REVIEWED 8Y------------- �` ;� ' 'CO dmf 1 Alterations and/or recommendationst---------------------------------------- ------- ---------•---=► .... � i ! ---------------------!-- ' - --------------------------- ----------------------------- =_= -f _fll � - -€ ---------- --' - yi ----------------------------------------------------------------- -- - - -----------{---------------- ------------------ - c F v ----------- ; t �.. - -------------- FINAL INSPECTION BY::.------- ---- ------------------------ -- �._. .. ae - -- ----------- ---------------------------------I---- . SAN JOAQUIN LOCAL HEALTH DIS RI�� 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Minteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO. �'""