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r7 APPLICATION FOR SANITATION PERMIT Permit No -------__.._--_--- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in complince with County Ordinance.No)49. L/ JOB ADDRESS AND LOCATION— rr?� '7_ = � ( � =G ------ Owner s Name------------ ------- - --- ` -----------eF rj IV ?fir 09, ---- Phone-//A-,,2_'3&-- ---- Address-------------- f/ ---- u Gx QTS/ , -------------------------- --------------------------------------------------------------------------.-- Contractor's Name ------- ' r---------------------- Phone �P-_" G- Installation will serve: Resident P4<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /__ Number of bedrooms __ Number of baths size ------ _---__------------- Water Supply:' Public system4❑ Community system ❑ "Private [l"Depth to Water Table --V�rft." " Character of soil to a�depth�of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O-`Hardpan ❑ Previous Application Made': Yes ❑ No R New Construction: Yes ❑ No r. FHA/VA: Yes ❑ No Ems` TYPE OF INSTALLATION AND SPECIFICATIONS: ? R ; (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) . } tic TaRk: Distance from nearest well----- Distance from foundation--------------------_Material--------------------------------------------------- No. of_cbrr artmenjs------------------------t-Size------------------ -_. --Liquid deoh--------------------------Ca acit -------- Disposal field: Distance from nearest well--IAA----- _Distance from foundation_-_Z-57--t-Distance to nearest lot line-_/-5------ Number of lines-------- --------Length of each line-----_---�-47 ..........Width of trench--,---------;-------------------- Type ------------------ Seepa if: Distance to nearest well__ �c Depth of filter material------/__k___.__Total length-_--___n?,,z-------------------------- Q • T e of filter�material____,�?i__ 4.Q_._,____Distance from`fou dation,:.......+..__.Distance to nearest lot line--- Linin material--_ - `r p 9 _ Number of pits------>/-.-------- - g - � Size: Diameter_"-•------------------.Depth-----s?-5--{--•-------•--- V� Cesspool;' Distance from nearest weld-------------- Distance from foundation-------------------_Lining material -_____---..-_--_----_-_-:----_._-_._ ❑ Size: Diameter '_Depth---- =-----------Liquid Capacity--=--------------- -----gals. Privy: Distance from nearest well------------_---------r_--------------------------Distance from,nearest building-----.-----------,-------------------- --Distance to nearest lot line= ri",".° ~~. . . " ---------------------------------- ----- Remodeling and/or-repairing (describe):--------------------- -------------------------•------------•----------------------- �---------=------------•------------------- -------E �1 ----------------------------------=------•-------------------------- ----- r ------------------------------------------z---------------------------------------_----------------------_---_---__------------------------- ------------------_----------__-__-_--___----.__---_--_-_---.----..-.--._---.-___ A I hereby certify.fhet l have prepared this application and that the work will be done in accordance with San Joaquin County[ , ordinances, #atel s, and rules and regulations of the San Joaquin Local Health District. n ner and/or(Signed) ------------------ -- - ----( / r Contractor) " --Title_ By= :.. - { ) --`--- ------------------ (Plot plan, showing size of lot, Iotaion of system in relation to is., buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `-: - ------- ---------------------------------------- DATE------%�-> --------------------- --,1 REVIEWED BY----------'-=------------ = - -- - - DATE----------- 3 BUILDING PERMIT ISSUEQ______________•----------------__---- _ DATE------- Alterations and/or recommendations----------------- ---------._...........---••--••----------•------------------------------------------ -----•- -•-------- .-...... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ �_ ------------------------------------------ ----------------------------------------------------- ------- ------------------------------------------------------_---------------------------------------------------------- -------------------------------------------- ---------------------------------------------------------------------•-------------------------------•---------------------------------------------------- ---------------------- ej FINAL INSPECTION BY::. �AQUIN -- Date --` U ~---�-----------------------------•-•---- SAN JOCAL 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.