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l to P ) fvo APPLICATION FOR SANITATION, PERMIT Permit No_ ________________________ * -� (Complete in Duplicate) 3 e�a_ Date Issued ---__I'{ 170 Application is hereby made to the San Joaquin Local Health District for a permit to construct and e --« d install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L�O]CATsI4O r_-- . --�► '_ _.._i-:-.�-_/-_* r ---------------------- Owner's Name_ , - 2 J �_� K t7 � P hone-------------- --------- ---- � Address 1 r -- -----------------------------------------------------------------------•----------------------------------------------------I------------ Contractor's Name--- 0---��------•-------------- --------- Phone........------•---•---------•-----. Installation will serve: Residencfe'` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ `Other ❑ Number of living units: _____ Number of bedrooms -4. Number of baths --- __ Lot size -_-_. ___f-_ -____________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: •Sand : Gravel [jSandy Loam El Clay Loam El Clay ❑ Adobe - Hardpan ❑ 1 Previous Application Made: Yes E] No New Construction: Yes ►(No E] FHA/VA: Yes E] -No R-/ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cess ool ermined i Public sewer is available within 200 { P . P A j PIS/ ) f1f Septic Tank: Distance from nearest well '._ ,_.Materia`______________r:::�!----^_EF --------- No. � 'KDistance/♦fyomy fQ�nava ion.--..____. - No. of compartments------- _-- --------S;ze__��C9---:_5'_----__!_ ---Liquidadepth------------1---------------Capacity------- -f`-� < Dispos i Field: Distance from nearest well___ _' fr istance from foundationt _- ---Distance to nearest lot li�_P�� f' 12� plumber of lines___________ Length of each line____________� _,i, Width of trench._.__-__t ,-.�-_.- Type of filter material__�A_t Z"�!�' '. Depth of filter material___.___ ,-_.______Total length---------- Seep it: Distance to nearest well_______{__�._-__��Distance from oundation 1_.-.Dist nce to nearest' t line --------- Number of+pits--- ----------------Lining material -?�_,&____-Size: Diameter_3,7 ___________.Depth-_ _ ___-___.____._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_____-__________._______.__._--... C ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity. --------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------.-_.-._--._. ❑ Distance to nearest lot fire---->---------------------------------------------------------------------------------------------------------------------------------------- -� Re�m�ing .a n/or repairing .es i e):-------------------- _________________ ------ ----- L--,:T=--------- ------- ; p ------------------ -�JZA'--- �-� !' ---�----- ------- --------- :aa------------------ ------ ------f-------- ._-.._------------------------------------------------------------------..-------•----_.._.::__... ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, Sta, a laws, and rules a/nd regulations of the San Joaquin Local Health District, (Signed).- -----��-- ------ - ---------------------------------------------------------------------------------•-------------(Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation to wells; buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�--------------------------------------------------- ---------------•--------•-••------------ DATE!------------------------------------------------------- REVIEWEDBY---------------------------- ---------- --------- ------------------------------------------------------------- DATE---%=- BUILDING PERMIT ISSUED---------------------------------------------------------- = DATE'' _ ------------------ ---------------------------- Alterations -Alterations and/or recommendations:---------------------------------- ` --------------------------------------- ---------------------------------------------------•----•--------•-------------------------------------------------------------------------------------------------------•--•--------•------------,.. ------------_------ ---------------------------------•--------------------•----------------------------------------------------------------------------------------------------------------------••-- ------------------------------------------- ------------------I--------------------------------------------------------------------------------------------------------- ----------------•----.--------------------------------------------------------------------------------------•-----------------------------------------------------••-- -------------------------------------------------------•---- ----------------------•- ------------------------------------------------------------------------- -------------- ---------------------------------------------------------------------------- ----------------------------------------------------- J � -�8 FINAL INSPECTION $Y:_. .. -____-- ------------------ --r Date------- f-[------------------------- SAN JOAQUIN LOCAL 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 , Revised-1=a7"i•�,Co.