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R <br /> 'A <br /> "N ...... <br /> 'APPLICATION FOR SANITATION .It No. <br /> (Complete in Duplicate) Date:1-ssued ...T <br /> 71;?�.17 <br /> \TA�plicafion is her <br /> made to the San Joaquin Local Health District for a permit to construct and install the work hereii4 clescribeid. <br /> kk is application is made in compliance with County Ordinance.No'. 549. <br /> ---------- ................... ------------- •.................................................. <br /> JOB ADDRESS AN,9>,OCATION. ------ <br /> ----------- ..................-----------........ ............ Phone..................................... <br /> Owner's Name--- - -- --------- <br /> Address-------------•------------ ........................•....__...._.....__._.._....-.......---•--•--••---------------=-------- ............-----•--------........_... <br /> Contractor's Name,....!.......%:�. .. .................---•---- '...................................... .-•__•---------..........­---------- Phone.......................... <br /> Installation will serve: Residence .4 Apartment House [I Commercial C] Trailer Court C] Motel [3, Other <br /> 7 <br /> Number of living units: -------- Number of bedrooms ........ Number of baths --- Lot size ............................................... ...... <br /> Water Supply: Public;iyife'MAK Community system [] Private [] Depth to Wafer TableX.3... ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F1 'Sandy Loarn E] ` Clay Loam[j Clay E] Adobe❑ Hardpan <br /> Previous Application Made: Yes E] No D New Coinstrucfion:;Yes Fj No ❑ FHA/VA. Yes ❑ No El <br /> TYPE"OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Distance from nearest well-SO------ Distance from found t' <br /> Septic Tank: D�st' . . ....... <br /> No. or' compartments... <br /> ---------Size -AV-* .-Liquid diapth-------ot.............Capacity./d <br /> Disposal Field: Distance from nearest e11,. ............ ------ <br /> Win Distance from foundation._..:___. Distance to nearest lot lin. each line........._ .- ____ ___�Widih of frisinch....1;'OT <br /> Number of lines....____ <br /> Length of'6a Aa, --. <br /> �j W4 <br /> Type of filter material___.. ..Depth of filter length___-____---- .......;41 <br /> Seepag Pi . Disfan -- -------- . .. .... <br /> m er of pits..__:._ .............Lining material.. .................... <br /> Cesspool, Distance from neares+j-well <br /> ..::.............Distance from founda+ion...-,................Lining material..............­material_...-___._.-__ ...._...__.__._____.. <br /> ' <br /> ElSize:-Diameter.__:._.......::..........:............De th-............................................._..._Li uid Capacity............ ............gals. <br /> Privy: <br /> Distance from--nearest Distanse from-nearest,buildirig,'t.. ................................. <br /> F-1 Distance-to nearest-lot .......------------------------ .......... ............................................. <br /> Remodeling and/or repairing-(clescribe):----- .....................t-----------_-•............................................... ..................................................... <br /> ......................... .....................---------- .................... ............................... ............ ..................................................... <br /> -----­---------- ------------------------------------------................................................................................. <br /> -------------------- .................*.......... <br /> ..........:!...........----------- <br /> ---------- .....................................................................I.......... ...... ............................................ <br /> I hereby certify-4hat I have-prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance- 'qk- -laws, and rules and regulations of the San Joaquin Local Health District. <br /> ,FT f <br /> (Signe ........... J-----------.--------------------------------_-_-- ---- ....................(Owner and/or Contractor) <br /> By:...........................-----------............................................................................___.......(T11410)---------i----------------------------------- ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> •APPLICATION ACCEPTED BY------------------* ..--..._.__._....._.._--•_---•-•_-•-_----._._.___.-•-•--- DATE................ ....................... <br /> ---------- <br /> ------...............­.............................. DATE_. ........... .........I................... <br /> REVIEWED BY._..._........................ <br /> BUILDING PERMIT ISSUED---_........ ... ............... -------- DATE-------7........................ ...... <br /> .................. ...... <br /> ... ............ <br /> - ---- ---------------------- <br /> Alferafi*ps and/ recommendations: ft <br /> ------- ------- --------- -----------*............ <br /> --------------- or k , <br /> 4 ate................ <br /> �----- ..... -----­--------------_--------------------------------------------------- <br /> ----------------- ..................... ---- ---------- ...................... .................­­................... <br /> ................................... --------- ----------------------------------------- ------ ----- ...... ................................................j------------------------------------------------- <br /> FINAL INSPECTION BY <br /> ..... ------------- Date,_ ............................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Sfroof 132 Sycamom Sfroot 814 N&A ..CIO Sfraa+ <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--9-2M - Revised 1.57 F.P,CO. <br />