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Application is hereby m This application is made JOB ADDRESS AND LO, Owner's Name -----/v4(. Address----------. - Contractor's Name ------- :7, Installation will serve: Rei Number of living ur Water Supply-, Public Sys Character of soil to a dep, Previous Application Made TYPE OF -INSTALLATION (No septic tank or'i Septic Tank: Distant wr�w , of 1r Disposal Field: Distant El Numbe Type o Seepa e Pit: Distant y Numbe Cesspool: Distan El I - ,- , .Size: [ Privy: Distan El Distan Remodgling and/or repd ---------- r ------ ---------------- . p,77C - -------- --------- ------------------------------------ I hereby certify that I ordinances, State laws, and (Signed)--------'` ' By: Signed)-------- By: ---------------- -------------- IpIdt plan, showing size of 1, ,< APPLICATION FOR SANITATION PERMIT Permit No ------ Z 0- Z.-? (Complete in Duplicate) Date Issued 1115-15-51 - -- - ------ 7 ------- "I to the San Joaquin Local- Health District for a permit to construct and install the work herein described. compliance with County Ordinance Noct549. :ATION --------- ezz, --------sy ------------------------------------------------ Phone__O_� ---- (��ez - — ----------------------- - � I 11197r, ---- -------------------------------- ---------------- - ---------------------------------------------- * ------------------------- ------ ... J ------------------------------- Phone I dente0" Apartment ❑House [] Commercial El Trailer Court Mo`t'e_1'[3_ Other - ts' Number of bedrooms41; _-Z--Number of baths --- Z_ Lot size --------- iIm ❑ Community system E] Private [B/ Depth to Water Table .4 ft. -- ---------------------- I i of 3 feet; Sand 0 Gravel El Sandy Loam D Clay Loom [:] Clay El Adobe [Hardpan E] Yes El No Rf `:New Construction: Yes El No 12/ FHA/VA. Yes El No e/ XND'SPECIFICATIO' NS: �sspool permitted if public sewer is available within 200 feet.) i from� nearest well_________________ Distance from foundation -------------------- Material I.ompartments -------------------------- Size- I ; .;A A 11 1 --------------------------------- ------_------------------- ----------------- -------- �_a Lpacjty--= ------------------- from nearest well________________ Distance from foundation ------------------- Distance to nearest lot line________..-_____. hof fines----------------------------- ----- Length of each line ------------------------- - ----.Width of trench ;filter maferial ------ Depth of filter material -----------------------Total Total length --------------------- I-------------------- to nearest well ---k, Distance from foundation ------ or I ------ A :p to nearest lot line - -1d of pits ------- / ----------- Lining material - I ;I 7.S�ze: Diameter ---- 9a-- ,- - ---. Depth_ .,Zw ----------------- from nearest well ------------- --- Distance from foundation---_-, -------------- Lining imeter --------------------------- --------- Dept h ---------------- material__.--___.._.____-___._____-_- ----- ----------------------------------- Liquid. Capacity ----------gals. from nearest weJl ------------------ --------------- -----------------Distance I e from nearest buiicling ----------------------------------------- tonearest lot line___________________ ----------------------------------------------------------------------------------------------------------- (describe):--------- ---------------------------------------------- ----- 72" 7V /4 e ------------------------ --------------------- ------------------------------------------------------- --- ----------- ----------------------------- ........................ ave prepared this application and that the work ork will be:dbne iii accordance with,San Joaquin County ulesand reguWions of the San Joaquin Local Health District. i .t------ ------ --------------------- ------- -----------------------------------{Owner and/or Contractor) -------------------- - ----------------------------- -------------------------------- (Title) ----------------------------------------------- -------------- location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT. USE 0 N LY APPLICATION ACCEPTED . BY REVIEWED BY --------------- DATE ----- /��o ---------------------------- --- --- - -- - -------------------------------------------- --------- DATE----- - --------- BUILDING PERMIT ISSUED -A 11 ---------------------------------------- --- ---------- ----- -------- ------ Al4erations and/or recommehafions:_,. ------- ! -------- -------------------------------------------------- -- -------------- DATE ----------- ------------------------------------------ ...... ------------------------------------------------- 111i ------------ ---------------------------------------------------------------------------- --------------------------------- I -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------- : 1. - ------- ---•------------------------------------------------------------ -------------------------------------------------- ----- - -------------- -------------------- ---------------------- ---------- P --------------------------------------------------------------- ------ -------------------------------- ------------------------------- 0. ------------------------------------- ------------------ --------------------------- -------------- S, - f ---------------------- ----------------- FINAL INSPECTION -BY..-i- .............. -------------- I ------------ Date -------- ------ ------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 W.,t'O.k Street 132 Sycamore Street, 014 North "C" Street Stockton, California Lodi, California -Manteca, Cilifor'nia Tracy, California ES -9-2M: Revised1-�P. CO. 57 F, .4 Ln 0 _r r_ 0