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too APPLICATION FOR SANITATION PERMIT Permit No. A(Complete in Duplicate) IDate Issued A Ii aion is. hereby made to the San Joaquin Local Health District for a pe�lrmif to construct and install the work herein described. ThisC is application.is made incompliance with County OrdlnancS,o. 549. JOB' ADDRESS AND LOQATION. - ------ ----------------------- ---------- ------------- ---------------------------------------------- ----------------------------- Owner's Name_A_rTAA� _n ------------------ ------------------------ Phone --- --------- ----------- ------------- Add ( -------------- ... ........... Phone__ Contracfor's Name -- ---- ..... AA... ----------- ---i. ------ Installation will serve: Residence Yj--Apartment House El Commercial ] Trailer Court [3 Motel E] Other E] Number of living units: __i.___ iNumber of bedroomsof --- I,- Number of baths --- L Wifer Supply: Public 'system t Community system E] PrivatelDepth to Wafer Table ft. Character of soil to a depth of 3 fe6f: ' Sand C] Gravel Ej Sandy Loam E] Clay Loam E] Clay Ej Adobe 6-*rq_ardpan ❑ Previous Application Made: Yes El No E] New. Construction: Yes F-1 No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is i available within 200 fee'*,) Septic Tank: Distance from nearest well-- Distance from foundation --- hp ..... --- Material k ------------------------------------------------- No'.- of compartmenis ------ -----------Size-A5.7 114 --- Liquid'�ep'fh_,_1q.2_.1 - - - -------- Capacity ;4 -- Disposal Field: i0ance from nearest -ell ---- 20 ____.Distanc6 from4dunclation ---- to nearest lot line---/ 0 Number of lines --_-•-------I _: f;' -1 Length o ea' c h line--- ?_r_1 of french ----- Type of'filter mate ria 1�-__hf ----- W Depths of aferial_'__X.0_'1 ......... Total lengfh__4 --- - -- ---- --------------- Seepage Pit: Distance to ne . a f1i t ------------------------ cel;�om*f ion -_.e5 � ----------- Dist nce to nearest lot line Nlu`�nbe'r of pits-_ j -----Lining mat Si e: Diameter---.;" ------ / --------- Depth .... AO ---------------- r___m Cesspool:Distance from nearest well ----------------- Dista ation El Size: Diameter ......... 11 ----------------------------- Depth --- ------------ k ------------------------- -- -.Lining material-------=----------- ------------------- --------Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well -------f---------- : ------------------------------ Distance from-nearesf building ------------------------------------------ --Disfance to nearest lot line ------ -------------------------------------- Remodeling and/of repairing (describe): --------- -------------- ---------------------- --------------- --------------- I ---------- ------------------ I . -1------------------------------------------------------ ------------------------------- ------------- ----------------------------------------------------------------- ------------------------- --------------------------------------- --- --------------------- i, -------------------------------------------------------------------------------------- ------------------------------------------ ------------------------- --------- ----------------------------------------------- ------- m ----------------------*------------------------- f" ---- I ------------------- ------------------------------------------------------------------------------------------ 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 and -regulations of 'the San Joaquin Local Health District. (Signed) 4) - -1- -------- ---------(Owner-and/•or Contractor) /A p y B ... /7A ..... ---------------------------------------------- ------------ ---------------- (Plot plan, Sowing size'of lot'locafion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- - --------- - ---------- ---------•--- ------ .- DATE ----- -- REVIEWEDBY --- -- --------------------------------------- -------------------------- ------------------------ N7-7 - — ---------_-------------- ----- BUILDING PERMIT ISSUED-------------- ---- - ---------- DATE --- ------------------------------------------------------------ DATE - ----- --- ---- -------------------- ----------------------- Alterations and/or, recommend afions: ------------------ ----------- -- ------------ --------- --- ----- ------ -- - - ---------------------------------------------------------- ------_----------- ------- --- ---- ---- ------- — ------------- - ---------- --------- I -- - ---------------------------------------------------------------- --------------------------------- ----------- ----------- -------- -------------------- ----------- _1 ------------------------------ ------------- ------------------------ ------------------------------------ --------------------------------------- T i - --- \ ----------------------- --------------- --I---------- --------------- •---.-...-------- ---------------------------------------------------------------------------------------------------- ---------------------- ----------- ---------- ------- --------------- .1 --------------- ---------------- --------------- ------ ----- -- -------------------------------------------------------------- I ----------------------------- ---------------- ----------------_-- FINAL INSPECTION -BY: -------------------- ---- - ------ ............ J---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California A ES -9-21v1 Rev;sed W-2100 814 North "C" Street Tracy, California