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j * .?PLICATION FOR SANITATION PL4,�,.. t No. .._.S--2f.L___.... . (Complete in Duplicate) mos R4, qff Issued .._9. �� ®slaication is pplcat'oner by madecto thance with uin Localnty Health D•lNoc f or a permit totruinsthe work herein described. JOB ADDRESS AND CATION---s offs 0---- - --------- ---- - -------------------------- ------------ Owner's ---------Owner's Name_.. Phone- ---------------------------- Address------- - ...... -4:2-4!.ln L/- ------------__------------- -------------------------- Contractor's Name------- - ~--------------------------- ------------ -------------------------------- --------------------------.. Phone----------------------------------- Insfallafion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 5( Number of living units: _...__ Number of bedrooms -------- Number of baths -------- Lot size .......__.....-...___....._--------------------_..._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water TablerSJ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welLcS -_...._Distance from mo�u/nd �on..lQ__..__.__.Materigl___ t7 ._...____y.._,.__... _Xy-_ts _Liquid depth--.----/f__-....-Capacity./. Ilk No. of compartments__. _ Size _. ---- Disposal Field: Distance from nearest ell, --------. Distance from foundation.__..---- Distance to nearest lot lin ----------------- dil f71 Number of lines-------- .._ _ ----- Length of each line-----_..-�- `� Width of #ranch._. / . l"` Type of filter material----- ---Depth of filter material. ------Total length--------/ I---------�. Seepag Pit: Distan -- - ----- um er o pits----- ----- m - '- -'--' ------'- .. . io ------- - •------ ---' --- ------------------'- Cesspool: Distance from nearest well .Distance from foundation_-----------------.Lining material--- ------------____-.............. ❑ Size: Diameter----- - ----- -------------------Depth----------------------------------------------------Liquid Capacity-"-----------------------gals. c Privy: Distance from nearest well---------- ----------------------------------Distance from nearest building----------------------------------------- 71 Distance to nearest lot line----------------------.....- --------------- ------------------------------------------------------____ r Remodeling and/or repairing (describe):-------- ......- ------------------ ------............-......----•--------------------------------- -----------_-----------_......... -----------------------------------------------.........------------------------------------------------ ---------------------------------------------------------------------------------------------------------- -' --------- ------------------- --- ---------------- ------ -- ---------------.. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancess�talaws. and rules andel regulations of the San Joaquin Local Health District. (Signed)-.u -+` !L-------'- �V- — --------------- .(Owner 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 B-Y- -....- -------- -- ----a-- ---------------'------- - --------------. DATE------------- Vq-.---- ' _ DATE -- --------------- REVIEWED -- -REVIEWED BY----------- --------- BUILDINGPERMIT ISSUED------- -- _ - ------ - - -------------- ------- �DATE------- ---------------------_----------------------- osand/ recommendaera -..----Alt - .............. '" ' ( -GtG .Fay2�/ i . . . -.......... ------ - ------ - ------ - - - --- - - - _ - ----- - -_ - ------- ------------------------------J------------------------------ -- - ---- ------- FINAL INSPECTION BY:-- ,// ----- Date.--L_. -.--_5�D.. 5.'---- -------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A Revises 1-57 F.R.CO.