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APPLICATION FOR"SANITION PERMIT Permit No. (Complete in Dupli ate)EXPIP?,'S ONE YEAR_, - ate Issued FROM ' FRDATE Application is hereby made to the San Joaquin Local Health District fo the work herein described. This application is made in compliance with County Ordinance No. 549. F JOB ADDRESS AND LOCATION---> ' ^ �- � Phbne �_+9 - -- 7_lf- Owner's Name---------------•------------------- I-------- - - - Address----------- ----------' -------s2--o-)------- : Contractor's Name--I----••------ { Phone ------------------------------------------- ---------- Installation will serve: %: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El ; Number of living units: I---- Number of bedrooms _3____ Number of baths 6;_kLot size ______f�___�____�42-_� __________.__.__ � Water Supply: Public system ❑ Community system El Private ❑ Depth to Water Table ________ ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: YeNo M,-�New Construcfion: Yes ,2"No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or'cesspool permitted if publi sewer is available within'200 feet.) Septic Ta k: Distance from nearest well_ _______Distance from foundation____ __ l --f-----.Material -- - --- X11-1--------------' 4 No. of compartments__ _' .________-_�____Size__ _k___y_X_ _-___Liquid depth._____�i�_f__________._CapacifY______p-�`______ DisposalFild- Distance from nearest well -f(v___.._Distance from foundation-____ ___ es _. ----.----Distance to nearest lot line f__ _________. � Number of #ines__'___,cr___ ___-___rr_'_ Length of each line__ i�_�____a♦ _'�__._.Width of french------�_9_____________________ 6' -�T e of fi{ter material___ _ 'u�______-De th of filter material______1 __ Total length-------p �1 1 OG �lS� � Distance to nearest well---- _ ----------Distance fro founclation___�'�_'_v________r__�-Distance to nearest lot line_______- `} ❑ ° _ Number of pits----- ------------Lining material---�.•__----Size: DiameterlRL(¢_1C_�o-__-Depth----�p_._________-----____- Cesspool: Distance from nearest well_________________Distance from foundation---.----------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------- ----gals. Privy: Distance from nearest well____--------------------------------------------Distance from nearest building----------------------------- -------- r.. ❑ Distance to nearest lot line A ; Remodelin and or repairing describe { --------------------=---------------------- -------------------•--------------------------------- -----------------•------------------------------ ----------- I -------------------------•------------------------------------------------------------------------------- i --------------------------------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules d regulations of the San J acluin Local Health District, f (Si ned 9 ------ - -------- --------------------------- ---- --- ------ ----------"--------------------------(Owner and/or Contractor) Plat fan, showing Size of lot, locatio --- ------- -- --- --- - ----- --- -- {Title) - ( P g �n of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---J4 -------- ----=---•`------------------------- DATE------9- -�; ~� -------------------------- jREVIEWED BY--------------------------------------------------------------------------------------------------------------------------- DATE---------------- ;------------------------------------------ [ BUILDING PERMIT ISSUED---•-----------'------------------------------------------------------------------------------------- DATE------------------•----------------------------------------- Altertions and/or recommendations---------=------ --------------------------------------------------------------------------•-----•------------- -----------------------------------=-------- f --- ------ --- -- - ----- -- �"�� - c� ---- ------------ --- --- -- - --------- -- - ------ -� ---------------------------------------------------------------------------------------------------------------------- -- _ ----------------------- ------------------------------ 11 -------- Date--------------- -- --tom-.- / ----------------------------- FINAL INSPECTION BY:-----_ ---------- -- --- ----- � l9'� t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.