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tips 7 t p APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) Date Issued -_1`__-'�--------------- 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. A JOB ADDRESS AND LOCATION`�� ----�_�_�0------Ls�-----_�,JI.I��.TP1--------------------------------------------------------------------------------------------- Owner's Name--------13-Q.4flt_......C-1------- .I -RZA)4-------------------------------------------------------------- Phone.. 0 VIA Address-•--•--------•--••-- ��`�--------E--1-------N i� ........................... Contractor's Name---- t--- G---.� ----'Dim- ------------ Phon -a--..------- ---%- s.`T KiO Me. 1=b� Installation will serve: Residency g Apartment House Corcial ❑ Trailer Court E] Moltel ❑ Other rte Number of living units. -------- Number of bedrooms I--- Number of baths _ Lot size ___ ------------------ Water Supply: Public system &2( Community system ❑ Private ❑ Depth to Water Table _4� ft. Character of soil to a depth of 3-feet: Sand'' Gravel ❑ Sandy Loam ❑ Clay;Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes [,7d No ❑ FHA/VA: Yes ❑ No TYPE OF; INSTALLATION AND SPECIFICATIONS: or'ce Se is Taokseptic t Dist ncesfpoml nearest delf h eDistanc sewer is avafaoble foundation within f��)..__.._.Ma erial------ l / J�- No. of compartments Sizes Liquid depth ----------Capacity-- -/ Di sail Field: Distance from nearest well N6v�o_Distance from foundatio ._(Q_____.___.Distance to nearest lot �ine__V__-___-_-__ ., Number of lines______'„ It __ ____ _________Length of each line_______---0-- __........Width of trench.___ _ Type of filter material--- --- p - g ' ( -.. f Depth of filter Total len th_______1to______________'_I_..__ I Seepage Pit: Distance to nearest well _-- 10UA___Distancitornp foundation_..._N© ...D st ;�e to nearest lot liner____--_____ �✓ Number of pits----- -t -------Lining material-- Size: Diameter---� ---------Dept h------�----------------- Cesspool: ----- ------Cesspool: Distance from nearest well-----------------Distance from foundation ____ Lining material-------------------------------------- E71 ______,___ .____.___❑ Size: Dfiamefer------------------------------------------De h -------------------------- -------Liquid Capacity . gals. Privy: Distance from nearest well-------------------------------- ___ Distance from nearest building_.,____ _. __ ------------ ---- _ ❑ Distance to nearest lot lin -----------------------------------------------------------•---•------•---------------_------- ---------------------- ---------- 1. r 11 Rem9derinq and/o epairing des ibe):--- --- -------- ... . ------- -- _ - ----- -- - . ....1d)___ I hereby certify t a I hav prepared this application and that the work wi a done in accordance with Joaquin + ' ordinances, State laws, nd rul regulations 4 the San Joaquin Local Healt District. (Signed)-"1. ------------- --- ---------------------------------------------------------------------------------------- Own and/or Contractor) By:---------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------- ----- ---------------------------- (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 APPLICATION ACCEPTED.BY-------------------- ..... -.....................•------------------- DATE-------•- • --4b1 -•• b1------------------------------- REVIEWEDBY__...._---- - - - ---------------------------------------------_ DATE �II-....-•--------•-•-•---•-----•-----••------ BUILDINGPERMIT ISSUED-------------------------------- - ---------_•------------------------------------- DATE-----------------r-••--------------------------------------- Alterations and/or recommendations---------------- -- ---------------------------------------------------------------- --------............................................ ----- J r "� 9 C 1+dam p a ----- n ••-----�f ,tea .._......... r -- ------------------------------------------- FINALINSPECTION BY--------- ------------------------------------------------------ Date----------------------------------- ------------------•------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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 . Revised 1.57 F.P.CO.