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yLo APPLICATION." �a� FOR SANITATION PERMIT per c.j1�r mr+ No. -- ------ - (Complefe in Duplicate) Date Issued Applica ion 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`Orddr ce No. 549. JOB ADDRESS-A� LOCATION__.- -- __ C� ! --- ----------•------••----------------------------------C Owner's ame__._ _ Address_.-----= .. : . Phone-4�._` $ --------•-----•------•--------•-----------------------•--------------------------- Contractor's Name--- ----------" -- @ i { ----- Phone --- --- Installation will serve: Residence Apartment House Commercial ❑ Trail Court Number of living units: _ ff {: l ❑ Motel 0 Other 1—I 1. Number of bedrooms _�_. Number of baths _�_____ Lot size Wafer Supply: Publics stem [ Y Communitysystem --• - •---`--"�-""""'--`-- '-- Y ❑ Private ❑ ©epth to WaterTable --_�_=_ ft. Character of soil to a depth of 3 feet: S7�New Construction; Yes Gravel [-] Sandy Loa Clay Loamf❑'tCla i Q Previous Application Made: Yes r iii y El1 Globe Hardpan [] oL'rJ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if, u6lic s wer is available ithin 200 feett] Septi ank: Distance from nearest wellI 'Distancp fro u -------•--- .Mater No. of compartments- , _--, -_ _ --. -- Dispos Field: Distance from nearest welt- - stance fro `Liquid depths_.- __ Capacity__.__ r -- ---. {{ ' f�/u m f undatian I_� ' Number of lines_____________"-__ istance to 4earest lot line______----- tom'\ f�-----------Length of each ine----- r3 - u )� I , --' i Type of filter material___-____-}_._I-- _-Depth of filter aterial_-_ - J - Width of trench--_-__---_� ---------------------- See a e Pit: I r. - ---------Total length--------.--, -------- p.9 Distance to nearest well-------__---_------_Distance from foundation__ Distance to nearest loft line_"___-."____. - ' ❑ Number of Pits_________________----Lining material___---_ ---- Size: Diameter ---- D pth Cesspool: � ' __ __ •, p Distance from nearest well_________________Distance from foundation_-__.- ".--_' _-.Lining�rr5ateri l." ,'+q,LTJ` s ------------------------------ ❑ Sizo: Diameter Depth_ f r -------- ------ -Dguid apadity----------------------------Distance from nearest well------------------------------------- gals. ______________________ Distance from❑ nearest buil i" Distance to nearest lot line--------- --- -----_ --- ------------------------------•--------------------------- -------d rr or - Re oncJ/ rep o' g , scr ------ --- ------------------ I ------------------ ------------------ --------------------------------------------------ia -C�--g----.�f�--. - ----.----•-------------•-:'-------------"-- --- ! hereby certify thaF'!'have* re red�Ai a is Fr&i,�d fhat a-work will`b M_'irfac Orden with San Joaquin ordinances, State laws and rul and re ula ons of the San Joaqulrl Local Health District. 9 County (Si ned 9 -•------------------ : { ----- BY--------•-- ---•-----t A (Owner and/or Contractor) (Plot plan, showing size of lot, location"of system in relation to wells" buildin (T1tieJ----_-._- t --------------------- gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ ------ ------ REVIEWED BY E ---------------------------------------- ---------------------- DATE�` '------- BUILDING PERMIT ISSUED__. ----- ------------------------------- DATE-- ------------ •-------- ---------- ----- ----- Alterations and/or recommendationz =-�,. DATE--------- - - ---- --- ------------- '"'' '== ----- ----- - = ---- ------------------------ ` - ,�9h- -- ------ j __ s r -------------- ---------------------------------------- ------------ ~ P!�'1!o.__ „ "_ ------------------ ------------------------------------------------------- Ca.e _ -_-;--------`�- -- ---------- FINAL INSPECTION - ____----__ - �-- a e 4-se-111, - ----- --- a ---------- -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT '130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California I Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100