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l .,,,APPLICATION FOR SANITATION,.,�_cRMIT Permit No. ----- .7-:7C (Complete in Duplicate) Date Issued Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance.No. 549. - JOB ADDRESS ANDCATION ---------C ------------ --= Owner s Name---- .-- ----- -- !- = U F --- Phone----••-•------- _7 1 - �7 �,_ A� Address F ' ------- -------'r ------------------ - M ------------------------------------------------------ - �--- Contractor's Name , " °t.±l�G�-f -. 3 ---------------. Phone-------------- ----- Installation will serve: Residence '❑ Apartment House ❑ .Commercial ❑ Trailer Co r ❑ Motel ❑ Ofih�y �� Number of living units: ------ - Number of bedroorns'__-i-____Number of baths _.a Lot size ____ : ,_�s _.--_-_---- Y. .. --1 !�' 9.. 4d �' Water Supply: Public system ❑ Coinmuni#y.system'❑"''Private` :Depth'fb-Wafer Table k, r Character of soil to a depth of 3 feet: Sand ❑3 Gravel ❑ Sandy Loam❑ Clay Loam [j Clay [] Adobex Hardpan,❑ e Previous Application Made: Yes ❑ Nc [ New Construction:. Yes ❑ No [ FNAZVA: Yes ❑ No ❑..�+" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if.public sewer is available hin,200 feet.) ^ Septic Tank: Distance from nearest.well Distance from foundation_ Material------------------------------------------------- I _______ ________ __ ___________ '� No. of compartments-:_ -__ -- -.{ Size--- ----- ' ----- -Liquid`depth---- --------- ---------Capacity______-•- -- isp sal Field Distance from nearest•well ��_ -" .Distance from-foundation_ S_--____ Distance to nearest lot li r. �� Number of liries�___'- - ----------------- x Length of each line----- ---7. qy Width of trench.. -- •�'--------------------- E ' / Total length------------ -- -�- Type offiltermaterial:57-5, -L.Depth of filter material____.__:_:._:-__--- Seepage Pit: Distance to nearest`"well _-"-- `"___Distance from.foundation_____________ `..Distance to nearest lot'line_---------------- Number __-___ ______- Number of pits- ---------- --Lining material----------- -------Size: Diameter-----------------------Depth-----•--- -------:-------------- p Cess ool: D stance from nearest.well----------------'_Distance from foundation_____________i-._-:Lining material----------------------------------- 4 ❑ Size: Diameter ----- De th---------------------- -------------- ------------Uquid Capacity gals. Privy: Distance from nearest well__ _ -----------------------------------Distance from aneerest building------------------------------------------- Y' _._ _- __._________-------------. ❑ _ +r..' "_; -- = ------------------------------------------Distance to°nearest lot;line :=`�_--- - ------------ , s .----orf {.r. _. " ''�'' �1.' - Remodel{m/�(..]+) and/o�rrtrepairin9'(desc;&)n�_.. � �'"-- - _ --------------------------------------------------- y E �• v-- ' ---------------:------------------------- - -------•- .t �_. ---------------------- ---=------------------------ ------------------------------------- ---- - I hereby certify that I have prepared this applicat ion anJ'thaii the-work will be done in accordance-with San Joaquin-County , ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. d Signed � fr'---�r-��-r4:�c.�'`:�`,�----- ---------- ----------------------------------------------------------------- ------____(Owner and/or Contractor] By=--------------f,-- ' '---- (Title)------------------------------------------------------ tan ---- ------ :--- __:-:.— ----.: (Plot plan, showing size of lot, location�of system in tela+ion to wells, buildings,, etc aan be placed on reverse side). FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY------------=---------- '� ------=------------------------ DATE --------------------- -- ------- REVIEWEDBY------------ ----------------== --------- ----- --- I -------------------= DATE---- --•q --,��•"" y -------- ---- DATE------------------------------- -------------- -------------_ ING AlterDat ons and/or recommendations: ------^ / l ----------- F 6 ------------------------------------------------- -----______.___ fi --•------•------' --------------------------- ---------------- I i _ - ----______________ _ ______________ _ ______ _ ______.._ FINAL INSPECTION •BY:..--=---- =-"`" r _.Date µ-- _..-__ -------------- ___-___._ ----------------------- ___ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M Revised 1-57 f,P.ca.