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__________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and relations of thoaquin Local Health District. (Signed') } _ -------------•-- .----- ---7+o -'----------------------b' r ��OwQjr and/or Contractor} BY: - --------------------------------------- (Plot plan, showing size of lot, location of system in relationwells, buildings, c., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------- 1 ---------------------------------------------------------------------------------------- DATE-------------------------------------__y REVIEWEDBY----------------------------------- -- --------------- -- ----- - - -- --------------------------------- DATE---------------- ----- BUILDINGPERMIT ISSUED ------------- ------------------------- ---- ------ - --------------------------------- DATE------- Alterationsand/or recommendations;-------------- ----------------- ----------------------------------------------------------------- --------------------------------------------- `--•-•----------------------------------------------------------------•--------------------------------•Ij ---•----•------------------------------------------ ----------' r ----- --- ..: -------------------------------------------------- -------------= --------------------------------- ----------------------------------------------------------- I -----------------------------______________ FINAL INSPECTION BY:._-- --- - --- -- Date --- 0��_�___�__ `✓v ------------------------------- - SAN JOAQUIN LO AL 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 . Revisecl 1.57 F,P.CO. �� - APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) „(v , Date Issued `I' y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r !� r { JOB ADDRESS AND LOCATION ---------- ------------ ._ l/ T- -- e11`�---------------------------------------------- Owner's Name------------- �------------------ - Phone --=------------------ --------- ae%.--- ° � - 2 - � `------------------------------------------------------ ` Address-------------------------------------------------- ---------- -------------------- ----------------------------------------------------- ..,---------------------------------------- Contractor's Name------------------------------- IBJ 1- f '---i r �s.i "` Phone�r` � -- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms -------- Number of baths -------- Lot size ------ . ------- -------- 9�k_-_-------------------- Water Supply: Public system 0( Community system F1Private r-1Depth to Water Table _V0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe& Hardpan ❑ Previous Application Made: Yes ❑ No it New Construction.: Yes ❑ No FHA/VA: Yes ❑ NoX , TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or'cesspool permitted if public sewertis available within 200 feet.) Se ^fik: Distance from nearest. well--__-_- _:__-= Distance from foundation__________ _______.Material__________________-_____________.__.________- �/(S Size Liquid depth Capacity No. of compartments ------------- C ^D,isposal ��____-Distance lot �+% Field: Distance from nearest°weld__ a Distance from foundatio,n---- to nearest rl� Z-)_ WLength line_______ AIS Width of trench__.___5%____.___.--_.-----__-_ [ Number of lines -------- ------- _____ of each Type of filter materiale�Daopth of filter material_____ fk__----_-_Total length_____. �_________________________ rn ,. e Seepage Pit: Distance to nearest weIl__�j4�A__-Distance from foundation___ ....... Distance to nearest lot line _--�'�_____._ Number of pits ----- Linin g materia?-_-_��AC _.Size: Diameter._'--____Deptn___.�________ Cesspool: Distance from nearest well _-----_Y---`�_Distance ifi�om foundation -------------- ____.Lining material _____.______-______.____.____________ . ❑ Size: Diameter ------E------------------ ------------- Depth -------------------------- ------------------------- Liquid Capacity-.- ------------------------ gals. jPrivy: Distance from nearest well ------------------------------------------------- Distance from nearest building._--_- -________________________- Distance to lot line--------=------------------------- ❑ nearest --------------------------------------------------------------------------------------------------------- t --------- Remodeling and/or repairing (describe): ''------------ I$_________________________________________________________:________________-___________rte-_�/____ •_ _-______ _ _____ _ _ _____- -------------- _ -r___---__._ __________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and relations of thoaquin Local Health District. (Signed') } _ -------------•-- .----- ---7+o -'----------------------b' r ��OwQjr and/or Contractor} BY: - --------------------------------------- (Plot plan, showing size of lot, location of system in relationwells, buildings, c., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------- 1 ---------------------------------------------------------------------------------------- DATE-------------------------------------__y REVIEWEDBY----------------------------------- -- --------------- -- ----- - - -- --------------------------------- DATE---------------- ----- BUILDINGPERMIT ISSUED ------------- ------------------------- ---- ------ - --------------------------------- DATE------- Alterationsand/or recommendations;-------------- ----------------- ----------------------------------------------------------------- --------------------------------------------- `--•-•----------------------------------------------------------------•--------------------------------•Ij ---•----•------------------------------------------ ----------' r ----- --- ..: -------------------------------------------------- -------------= --------------------------------- ----------------------------------------------------------- I -----------------------------______________ FINAL INSPECTION BY:._-- --- - --- -- Date --- 0��_�___�__ `✓v ------------------------------- - SAN JOAQUIN LO AL 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 . Revisecl 1.57 F,P.CO.