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UA o) st 2-- APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued ... J. A described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made,in compliance with C,,ountv--Ordinance No. 549. JOB ADDRESS ARID LOCA T49N I _4470-- --------------------- - ----------------------------------------------------------------I----- ------------------------------- Owner's Name---- ---- ------ - --- --- -- -------- -A ------------- -----------:-------------------------------------------------- Phone---------..----------... ------ f Address--------------- --- - - -------- -------------- -- - --------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------- ------------------- - -----y---------------------------------------------------------------------------- --------- Phone-------------------------------- it Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court 0 1 i ❑. OtheIr 0 ---------- Number of living units: ---I-.-- Number of bedrooms%3--- Number of baths -1----- Lot size -------------• Water Supply: Public system "E] CoIrrirnl6inity system'[]—Priv ati'R*`Depth'to'W' ater:Table—---- ft. Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam [2' Clay Loam [] C I lay E] Adobe � Hardpan Ej Previous Application Made: Yes []j No V New Construction: Yes Y-ON. F1 FHA/VA: Yes C No 0 TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank or"cesspool perkftecl if publj*c seweis available within 260 feet. D 'I , '0_ __ isiance from foundation-/ newest wel Se t' T nk: Distance from ear -- ---- -- ---- i Z 'Y 47 Liquid IdeRth......... --- -------------Capacil;yy-----4---a-p No. of compartments________--_ . ....... ------- Distance from n, ��Distarlce from foundafion/.6?��_ istalnce to nearest DispcsaleField: nearest welig, I arest lot line ........... ------ ' Length of each line___ Width of french ;jw Number of lines---- ------ ------------- Type of filter ma Qepth of filter material--------L, _---_Total length------------ Seepage Pit; Distance to to nearest lot line________________- ❑ Number of pits--"--------------------Lining material---------------4,_Size: D;amefer------------------------Deptk-------------------------------- Cesspool: Distance from nearest earest well---------------._Distanc6 from f.o.unclation--------------------Lining material--------------------------------- Size: Diameter- I--------------------:----------------De ---Liquid -Capacity-.----------------—:*---gals. D Dep -------------------n-------------------:------ -- -------- "Lfrom nearest building__-__--.-------___________.________..._. ❑Privy: Distance from nearest well--:--------------------I------"-"""'---_DistanceI- i Distanceto nearest lot-line------------------------------------------------------------------------ --------------------------------------------------------------------- Remodprin nd/cl repa'rirfg ( scribe):---------- --------------------------------------------------- ----------- --------------------------*------------------------------------------------- r -----------------------------------------I----------------------------------------------- -------------------- Ii�- ------------ ------ ---------------------- ------------------------------------------------------------------------L--- -------------- --------------------------------------- AA_ --------------------------------------------- ------------------------------------------------- I hereby certify that I have prepared this application and thai the work will be done in accordance with San Joaquin County e laws, and reulesn egu aflonsocif the San Joaquin Local Hea'ltk District. ordina'rice,>-St-1 , -----------------I----------------------I---------------- --------------- -----(Owner and/or Contractor)(Signed -- ---- ------ - ---------(Title)-------------I--------------------------------------------- sy -------- -.--i------------------------------------------------- -------------------------------------------------- -- i (Plot plan, sho ing size Of lot, location of system in relation to wells, buildings.i6tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-- --------------------------------------------------------------------------•-------- DATES.------------- -------------------------------------- REVIEWEDBY--------------------------------- ------------------------------------------------------------------------------- DAT E -------------------------------------------------- BUILDING PERMIT ISSUED------------ ---------------------------------------------- ------------- ,ODATE------ ----------- ------------------------------------------ 74m�_. 1�ro_ I- -- Alterations and/or recommendation, '04 __aAo------64, �v --------------------------------:---------- ----------- - - ------- - -- --- ---------- �_Ojn:;x----------------------- ------ ------- - -------------- or- ------ 0 - --X---- ----- -_-" ---------- ---- - �----- __------ t -- ----- - �- - -- - -- --- ---- ------ ---------- ------------ - Date.-.-_--------------------------------------------------------------------------- FINAL 'INSPECTION BY:.---- ---- ------------ AN JOAQUIN LOCAL�EALTH 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 Revire6 1.57 F.PrCo.