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-4- 9 1✓ APPLICATION FOR SANITATION PERMIT Permit No. I r/ (Complete in Duplicate)[Comp _ ,,- P � Date Issued . -�-•-1"--•-'s---- Applicatiowis hereby'made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made,incompliance with C my Ordinance No. 549. �6 �3 JOB ADDRESS AND LOCATIO .- -- --- "� _ •_�__-- _ Owner`s Name---------------- ' -- -- --------- -- ------ ----- - ;Phone ---------- - 1 ----- � - c Address._.--------- - - - -------------------------------------------------------•------------•---•----------------------- - --------------------------- ------------- Contractor's Name---------- Q1 --------------------------------------------- -- ------------- Phone--------------------- Installation will serve: Residence t-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` !_ Lot size _: -�� -` . . Number of baths ______ Number of Living units:_ of bedrooms , , 9 Water Supply: Public system ❑ Community system e Private ❑ Depth to Water Table _-/M- 11. _it Character of,.soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam El Clay El Adobe Hardpan ❑ !1.. r;l Previous Application Made:' Yes ❑ No [ New Construction: YesNa ElFHA/VA: Yes f[ "No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " ' [No septic tank or cesspool permitted...if public sewer is available within 200 feet.] II i g•` r Septic Tank: Distance#from nea}e'st ,well__ ______________Distance from foundation----�i�'______.Matersal___ _____. __. __Li Liquid de th_" --------------Capacity-- --y , compartments_------ --------- Siz - Q p 1 Disposal Field: Distance from nearest well-�_"�'_Distance from foundation__"_�_ __._-Distance to nearest to hn No. o Number�of lines:,------ _-- __ngth of each line---- _-- Width of trench----- - --------------- ---- w_�. - -. /._. [�' , Type of filter material_ f � epth of filter material:_T -__W__Totahlength__ ---------------- ---- l - e� / '�' -___Distancre fr m fo dation �,? _____..Di a pito nearest lot line y Seepage P,it: Distance to nearest ekL_'_______________ .. �} � � Num0er of pits- .--i --.-----__Lining material_-"> �.-Size: Diameter-___ .,?_.- Deptn___. -__ __ Cesspool: Distance from nearest well-----------------Distance fo- foundation--------------------Lining material__.______- __--______-___------_____ ------------------- --Li Liquid Capacity ............................ ___--" ____-gals. Size: Diameter--------------------------------- Depth_----`�!Ej . E yDistance from nearest building ------------ Priv Distance from nearest well ------------------------------------------' g------ ----------------- � ❑ Distance to nearest lot line--------- --------------- - ------------------------------------------------------ I� ' Remodeling and/or repairing (describe):---------- �J L ------ , 1 �� ----------------------�..k,.: .� -------------- ------------------- I ------ --------------------------------------- ------------------------------- - ;----------- --------------------------------''-------------------------------------------------------------------- ------------------------------------------------------- I hereby certify thaf I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r es and regulafions of;the San Joaquin Local Health District. (Signed') r Contractor) ------------------------ ,fs -� (rtle] k [Plot plan, showing size o______ " ------------ g f lot, tion of system in relation to wells, buildings, etc., can be placed on reverse side). 1 1y F_OR_DEP_ART.MENT,USE ONLY r , APPLICATIONACCEPTED BY -------- `�� ----------------------- ------------------------------------------ DATE------------------------------------------------ REVIEWED BY-------------=--!`------------------- -------------------- ---"------------------------------------ - DATE----------------------------------------------------------- ----------------------- -- - BUILDING PERMIT ISSUED--------------------------------------------------------------- ----- DATE - Alterations and/or recommendations;------- - ------ --- ------------------ ------------- --- ------------•- yy � ---------- `T arTH- ------- -----------: ------- ----- - -------------------•---- 4----EFS �`-�,®_ F ---- ------------ ----- --------------- ------ - --- ------ -- ------------------------------ FINAL INSPEC Dater--.Y --------- - ---- --------------------------- II SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street '°" 132 Sycamore Street81�YI+tor "C" Sfree+ Lodi, California T'Manteca, Ca7ifornie Tracy, t Nfornia Stockton, California II I •t ES-9-2M Revised l-57 F.P.CO. P