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�0 APPLICATION FOR SANITATION PERMIT Permit No. f 1..... (Complete in Duplicate) - Date Issued -----___ -6 --- Application is hereby made to t'he 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 J JOB ADDRESS AND LOCATION L.-. - ---- --------------`--------'------------------------------------------------=------------------- Owner's Name ------- Phone------------------------ Address---- �= _ - '_--F ------ --- --------------------------------------- A _` " • ; L Contractor's Name y Phone - --------- Installa+ion will serve: ; Residence J 'Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s, Number of living units: __ __ Number of bedrooms -A- Number of baths _/_= Lot size ------------------------------ _00 Water Supply: Public system Pr-Commuriity system❑' Private ❑ 'Depth to Water,Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑"� Previous Application Made: .Yes'❑ No 9��New Construction:- Yes ❑ No'A FHA/VA: Yes ❑ No 94— TYPE OF INSTALLATION AND SPECIFICATIONS: T-r+] F (No septic tank or'cesspool permitted if public sewer is"available.within 200 feet.) pti Tank: Distance from nearest well_________________Distance from foundation----.---_____ ___ _-Material______----- ---- - - ---____- __:.._____- No. of,compartments------- ---- -� :_Size---------------=------=---------Liquid depth-------- -- ------------Capacity------------------- ?,e �t � -- Dis al Field: .., Distance from nearest well.. ............Distance from foundation-------------------.Distance to riearest lot line___-__-_-__-_____ s I%/ _ Length of each line____ ____ ____ �` XOV Number of lines_________ _________ _ ___ _. �r�7_ ____-___-Width of french._____��r_ Type of filter material-/ _ . . _ epth of filter material___ 6 {-=_._Total length__--__e.�.! ---------------------- o ____________________ al Seepage Pit: Distance to nearest well-` +Distance frgm o dation_ __T__....Dis a�nce to nearest lot line-24---_.___ Number of pits:_____.___'___---Lining material Xr___I a.Size: Diameter-X,X--- --------Depth-----)A:F'_�2� Cesspool: Distance from nearest.welL_____________"_Distance from foundation-------------------------Lining material_________________-__.______________ ❑ Size: Diameter-------------"-------------------- _ `"_...!_Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we11__ ____:.___ -------------------------------.-Distance from nearest ❑ building______________________--____._ - Distance tonearlt lie - ---- --=-- ---------- --------- . \ Remodeling and/or repairing (describe):-- ------------------------- -------- �______.___ --------------------------•----•------•---•------------------ --------------------- y = y --- ----------------------------�---�---- ------------------------------------------- --------------- --------------------- j ----- - -------- ------------•------ ------------...-.-----•----------------- ------- -f l ___________________________________________________________________________________________.________-_-________-________-______________-_..__-__________________---____-_______________-__-____-___-__-____ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin-County ordinances, State laws, and rules an regulations 2f the' San Joaquin Local Healt District. " > -° ��" r Contrac (Signed)-------------------- _. . __t A,��_ -.- - --- �� By------------------ ---- --------------- -----------------------------------(r+le]--G (Plot plan, showing size of lot, I ion°of system in relation to wells, buildings, etc., can'be'place�d on revers Ede]. FOR DEPARTMENT USE ONLY: APPLICATION ACCEPTED BY - - -------- ------------------ DAT8�f7 -------------------••----------•- REVIEWEDBY----------------------------------------------•--------------------------------------- '-------------------------------------- DATE----------------------------------------------•----•------- BUILDING PERMIT ISSUED-------------------------,. _ DATE _--------:---------- _----------- r recommen tio - -_f-- _f�"--____-- Alterations and " �/� ns:-'--- = - --------- - -----------=---------- ------ -------------------- ----- ---------------------------------------- ---------L----------------------------------------------------------------------------------------------------------------------------------------------- ------------------•-•---------------------------------------------- -� _. FINAL IN5PECTIQN BY:. _ ------------------ -------- - = M ._. w . Date`= ------L____--=-------------------- _------ - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street x .. r' 3132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California"l, Manteca, California Tracy, California k ! E5-9-2M , Revisal 1.57 F.P.CO.