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—Perm ------ P-0 it�No4 APPLICATION_FOR SANITATION RMIT (Complete in Duplicate) Date Issued it to construct and install the work herein described. App ication is hereby made to the San Joaquin Local Health District for a perm fiance with County Ordinance No. 549, This application is made in complian, I--- ,r ( a :? - - -- -- - --- ---------------------------------------------- --------- JOB ADDRESS AND LOCATION------------- --- ------------ -------- --- --------------------------- ------ - Phone------------------------------------- ___-V-------- -------- ------ Owner's Name----------------------- :.. 4_7 ------------------------------------------------------------------I--- Address_-------------------------------------------- ---------------------- -------------- ...... --------------------------------------- Phone---------------------------------- Contractor's Name_______________________ ------ ---- --------- -- ------- --- nt House 0 Commercial [I Trailer Court 0 Motel [3 Other C] r, Installation will serve: Residence 91415_1�fme bedrooms --i--�<mber of baths ---I---- Lot size ------ cam --------------- Number of living units: _).----"Number of ystem [] Private R-5-p-i-h to Water Table -------- ft. 0 Adobe E--M-5rcfp_an 0 Water SuPPIY-- Public, system F� Community S Clay Loam 0 Clay ❑ Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam D �Iw construction, Yes 95�� Previous Application Made: Yes 0 No INSTALLATION AND SPECIFICATIONS:TYPE OF INSTALL ol permitted if public,I ewer is available within 200 feet.) - Mat ria -- ------------- ic tank or cessPo , d j n---- ----------- ria� (No septi 0 Distance from found &L nearest well--1=5---------- Capacity--- So tic Tank: Distance from e,--)L )�*jquicl depth-------- ----- No, of compa"irtments---------------------;--- -� t Distance to nearest lot line`_--- Distance of°lines arest well-J --------Disrato -----+0------- _ _Disposal Field: I )th ofeach line \ iWidth of french------- ------ ------------- --- -- Number ------------ --------------------Len( ---------- - -------- tb----------1-a--------------------- --- of filter rnafer;al----- --9------------Total leng JUI ----D,P't Type of filfer.maierial-5iMl- from -_Distance to nearest lot line----------------- earest well stance f foundation---------------- Seepage Pit: I Distance to nearest ----------------------Di Size; Diameter---------------------- Depth--------------------- ------------ Number of pits---------------- Lining material----------------------- ❑ nce from foundation-------------------Lining material------------------------------------- Distance from nearest well__-______-------Disfa ---------------- Liquid Capacify-- -------------------------gals. Cesspool: ------------ ----Depth----------------------------- El Size: Diameter------------------ Distance iarneter------------------- Distahce from nearest building----------------------------------------- N Distance from nearest well-------------------------------------- ------- --- --------------------------------------------------- ---------- Privy: Distance to'n'earest lot line-- --------------------------------------------------------------------- - ----------I--- - ---- ---------- lescribe)-_ A ... --------r- ng a or r,"Pa ----19 Re mod*U�� w. .......:�........ ----1--------------------------------------0------------------------------------------------------ ------------------------------------------------------------------ ------------------------------------------------- F ------------------------------------------------- , Joaquin County -- ------------------------------------- --------------i---------------------------------- d that the work will be done *in accordance with San Joa I hereby certify that I ha4 prepared this application an I Health District. ordinances, State laws, and rules and regulations of the San Joaquin Loca ----------------------.---(Owner and/or Contractor) 4 ------------- ------------r----------- ------------------------- ---------- - -------------- (Signed)------- -------------------------------(Title)--------------------------------id )------------- ----------- -- --------- By-----------------------------------location of system-fern in relation to wells, buildings, etc., can be placed on reverse (plot plan, showing sixe of 10t`,� FOR DEPARTMENT USE ONLY k -13-,--------------- DATE---------/.— ---- .............. ----------------- APPLICATION ACCEPTED BY------------------------ --- ------ DATE--------------------------- 3 REVIEWED BY------- -------------------i DATE- ----------------------------------------------------------- BUILDINGPERMIT ISSUED___J-------------------------------------------------------------------------- ------------------------------------------------------------------------- Alterations and/or recornmenclations ---------- ------------------------------------------------------------------- ------I---------------------------------------------_---------------- ----------- -------------------------------------------------------------------------------------------------- --------I--------------------------------I--------------i -------------------------w . , ------------------------------------ --------------------------------I------------------ -------I------------------------------------ ------------------z------------------------------------I------------------------ \_11---------- -------------------------------------------- ---------------------------------------------------------------------------------------------------- ----------------------- ---------------------------------I ------------------------------- ------------------------ ---------------------- -------------------------------- Date-- ---------- ------------- I ---------_--- - FINAL INSPECTION BY:-'----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 014 North -C11 Street 300 West Oak Street 132 Sycamore Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California S-9-21v1 1()-52 Revised W-2100