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I', �� or N APPLICATION FOR SANITATION PERMIT Permit No. *AA (Complete in Duplicate) Date Issued T_ 31. Application is hereby made to the San Joaquin Local Health District for a p6rmit to construct and 'install the work herein described. This application is made in compliance with County Ordinance No�49. JOBADDRESS ANfmCATION-----------4U/_-a--- -- ---- - -------------- ----------- ---- ---------------------------------- - ----------------------- Owner's Nam ----- -- -- ---- ------ - ---- ---- --------------------- Phone Address..- _1r1_ -------- ----------------------- - - ------- 7--- --____- ------------------------------------ ----------------------------------------------------/_" tor's Name - ------------------ Phone-_ Contrac ----------------------------- - -------------------------------- Installation will serve: Residence 0- Apartment House F Other I I Commercial [-] Trailer Court,EE] Motel Other El Number of living units: __/---- Number of bedrooms Number of baths ---1___ ------------------ Water Supply: Public system K Community system El Private F-1 Depth to Water Table/ft. Character of soil to a depth of 3 feet:1 Sand F Gravel 7Sandy Loam EClay Loam EClay EAdobeX Hardpan E Previous Application Made: Yes E] NoNew Construction: Yes [�r_ No E] FHA/V Yes D,, No TYPE OF INSTALLATION AND S1 . 4CATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic I.ank: Distance from nearest well________________Distance from foundation....................Material------------------------------------------------- No. of compartments--------------------------Size--------------------------------Liquid depth-- ----------------------Capacity----------------------- DisposalXe Id: Distance from nearest we11--------------._Distance from foundation--------------------Distance to nearest lot line_______________ Number of lines-----k-----------------------------Length of each line----------------------------.Widtb.,of —---------- Type of filter mate�ial--------------------------Dgpth_Q _ � ilter material-----------------------Total length-------_--_----------------------------_- / seepagZt.. Distance to nearest we1l__,_w�------j-Distance from fflundation-/ ----------Distance to nearest lot line of� pifs-----/ -- -- ----------Lining m' aferial,_ _____--Size: Diamefer___:i;Y_____________Depth____ -6- Cesspool: Distance from nearest well---------------!-Distance from foundation-- --------------- Lining material____-..________ -_______. ❑ aterial----- ------------------------------- El Size: Diameter--------i----------------- E Depth ---------------------------------------------------Liquid Capacity--------------------- -----gals. LP Privy: Distance from nearest well----- --------------- _____________Distance from nearest building______________________ ----------- ❑ Distance to nearest ]of line---------------I------------- ------ ---- ---------------------------------------------------------------------------------------------------------- Z 7 - Z RRemodd repairin &ibb): ---------- 1:-------155t . - ---------------------------------------------------I----------- ---------- ----------- ---------------------------------------------------------- --I----------- -------------------- 71 1 4 — - - =� -----------------------------------------------I---------------------------------- -------------------- -----------------------------------------------------------------------177777777= ----------------------------------------------- - r _________,__--- - --!,t----------------------------------------------------------------------------------------- - ----- ------ --- I hereby certify that I have prepare -this app? be done in accordance with San Joaquin County the ad fhaf the w ,,j op o,, e S VHea ordinances, to laws, and rules and ulations c qujA Local'Health alth isfrict. jSigned)_ --------- ---- -- ------------------------- (Owner and/or Contractor) ------ -- --- --------------------------- ------------------------------ --------{Title ------------ ------ - ------ _- ---- --------- -- buildings, --------- --- (Plot plain, � ow g sill of oc ion of system in relation to ells, buildings, efc., an be p-aced�cedon reverse e). 4 FOR DEPART 'ENT USE ONLY APPLICATION ACCEPTED BY---------------------- --- - --------- ----------t---- ----------------------------------------------------------------DATE----- � .............................-.- . REVIEWEDBY------------------------------------------------- - - - ---------- PATE --- -- -- - _ --- - ---------------------- -- BUILDING PERMIT ISSUED--------------------------- -- DATE--_ ------------------- - ------------------------ Alterations and/or recommendations:-------- - --- ---- . 4 --------- --T �- -- ------------------------------------------------------------- --------------------------------------------------------------------- - I - - --------------- - --------------------------V-------------------------------------------------------------------------- ------ _rl 7 ---------------------------------------------------------- ::-:�---------------------------------------- ---- ---------------------------- -111111 FINAL. INSPECTION BY:------- - ------ ------/---- ----------- ------------------------------------------------- --- - -------- -------------------- It SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO.