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;APPLICATION FOR SANITATION PtK Jt No. ..-S-2/1..... 4 (Complete in Duplicate) Z/, (Sl Date:Issued ...Tlv�47 \TAglicatiori is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des crib6d. This application is made in compliance with County Ordinance,No. 549. JOB ADDRESS AND IrJOCATION.... ----------.5------ .................... .............. ..................................................... -----_ Phone--- ......................... .. ... ........... Owner's Name... "_L; -----_-------------__----------- - ------------ -- --------- Address---------------------------- .................................................. ............I..............................................;....................................... Contractor's ..........................t-........................................-1........ ............. --- Phone............................... Installation will serve: Residence .4 Apartment House [] Commercial [] Trailer Court C] Motel ❑ Other 7 Number of living units: ...----- Number of bedrooms ........ Number of baths ... Lot size .................................... Water Supply: Public;iystemx Community system [] Private [] Depth to Water Tablj->'_.. ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] *Sandy Loa?n [] '%Clay Loam 0 Clay E] Adobe E] Hardpan 0� Previous Application Made: Yes 0 No E] New Construction: Yes ❑ No E] FHA/VA: Yes F-1 No ❑ TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: D�st ance from nearest Distance from-founTdt�'on..X_-_.r- Materi$l.... No. of compartments_ ?--- -------------Size/A.. _Liquid depth_..................Capacity- I.e.; Disposal Field: Distance from nearest. 11,.............. Distance from foundation Distance to nearest 11off 11"n Width of trench....>_ NA ber of lines...._.._ Length of each line._......._. �rn Type of filter mater Depth of filter maferial,/X.__!!A._.TotaI length-_-........A A .0............;40 Seepag Pit Dis !111111, ----------- um er of pits...._.. _.......... Lining material. io -------- .... .... .•-..--•------- Cesspool: Distance ..............Cesspool- Distance from nearest ..............Distance from.foundaflon.. .................Lining material_.....__...._..........:._____.____.-- ��I ❑ aterial............... --------------- Cl Size:-Diameter_-.----j ---- ................ Depth............---------.............................Liquid Capacity...._._....-----------------gals. Privy: Distiiince from nearest ...... -..,J'.,Distance from-nearest'buildioig,'-- --.-------•___._.__..:... Ntance-to nearest lot .......... -----------•----------: ----------------------------------------7.......... Remodeling and/or repairing-(describe):-----_-----_---------- .....•----•-•---•----•----•------•---••---•----•------• ..--•-•-•------•-•--•--------•-----..____._..._...__.. ..............................------..................................--------............ ---------------------------- .......... ................................. ............. --------------------------------------------------.......................................................................*-------- ...................................... ........................ --------- --- .................................................................................................................-_1.................................................. I hereby cerfify'--fha+ I have prepared this application and that the work will be done in accordance with San Joaquin County T laws, 4 ordinance!$, 7f I and rules and regulations of the San Joaquin Local Health District.cl .......;� Signe _------------- - ...................(Owner and/or Contractor) ( ............wlip-I&AP,------- -------I_-----_-----_---------- By:...............................................................I....................................................................(T -----------------------------------------------------------_- (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 ........... -- ---------- Z�: ----------------------- ................ ......... .......... DATE__ % - -----------------------------------------X BUILDING PERMIT ISSUED.................. ---6 ___.............................._ DATE........ ............................................ APPLICATION ACCEPTED BY..' . ............._......................................... DATE...... .11 `7 -- ------------- REVIEWED BY_......... ------ ----------------- -- Alteratippis and/ recommendations: I I I ...... -------- i, ------- ------- -------- ---------------------* ZA.Z�_ ............ .............................................................................. &4. e. ee- ........l..................... --------- -- -- ---- ------------------ ...........I........... I..........__.._........._......---•--........_.. . ............................................ .---------------............. . ..... ... .........,................................................j------------------------------------------------- ZJ&FINAL INSPECTION By:.- .......w Date.... `r, -=... .. .......................... .....?, $--- p SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stroaf 300 West Oak Street 132 Sycamore S+ra*+ 014 NorA I.C.1 Sow Stockton, California Lodi, California Manteca, California Tracy, California ES-1-2M- Reviseo 1.57 F.P40.