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��-�-r---� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) _ n pate Issued - E 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 Ordin e No. 549. + 112�' ----------------------------------------------------------- JOB ADDRESS AND ATIO Ph . --------------------------- -• ----- ------------------ ----------- Owner's Nam .._�_ _ ;T _ r -------------- . ohe_ . s �. ----- ------------ -- ---- - Address on Ph e. ------•- Contractor s Name--- •---•---- } ` Atartment Hou Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: 'Reid P , Lot sae d ------ , Number of living units: _-� Nu`fmber of bedrooms-- Number of baths __`--- ,� :� Dei th to Water Tabled 'ft" Water"Supply:' Public system Community system.❑ P'rivate ❑ P Y Sand Loam El Loam El . Clay ❑ Adob Hardpan E]Character of soil.to a'.depth of 3 feet: Sand E] Gravel ❑ y Previous Application Made:' Yes El No E ` New Construction: Yes No El OF INSTALLATION AND SPECIFICATIONS: (No septic fank'or cesspool permitted .if public sewer'is available within 200 feet.) a " r �.-t•,-.. '. , » _ ----------------- - Septic Tanks Distance from nearest wei4__ __.__-- "---Dis}ante from foundati�ln quid de th__Material ,Capacity______.__ No. of compartments-- ------size---------------------------- q P• ° R Distance from foundation___'_______________"Distance to nearest lot line__- _____.-_ Dispos F ;Distance from nearest well----------------- t °`` Number of;1ines Le,,ngfh of each line _ I-----Width of trent _.__.. rType of filter material--------------------- Depth of filter material_--------------------Total length_______" _ ------------------• /Distance to nearest well_ �_,_, ___��_Distance m fo dation__ -_Q"___.___-_.Distance to.nearest lot"line----------------- ---- - Seepa a Pit: .. ,�_` r" _ / ., -.Size: iameter-------I... ----+_.Depth----/3 I�luimher of pits_,/---------------Lin:ng ma »- est well__- __...._ Distance.from foundation____ ,__.Linin ,material---- --------- --------- ----- istance from near Cesspool: *' De th - e == • - =. --:Liquid-Capacity-------- - 0 ----- -----------9als. ❑ .mss -S,! e:-Diameter- -- ' Distance frorrmtnearest w0_.: __ __ .-_Distance from nearest Privy-. -- ------------------------------------- --------- ------------------- - ----------- ri t __ ------------------------ -••�-+-�- Distance to nearest lot line_-"-__-~_`_"- _ - El _ - --- ----- Remodelin a rep ng jdescribe1---= ��' _ ---------------- ------- t -`- - ----- { _.____y i _ ..__._ __ _ r .� ____________________ 1. _ __ ___ _________________________________________________________________________ � F �r - - 1 - ________ ------------------- _-_________s_--_____..__.______--____-___._____._____.___.----------- --------------- __.._____ ..___.____-__________________________.___. ________.___ hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County and r regulations of the San Joaquin Local Health District.; o inances, State I - i I .. ------- wner and/ Contractor) ------- (Signed) - -------------------- ------------ ----- --------- ( .g ) - BY� ------------ ----------------------------------------------- ---(rt (Plot plan. showing sire to Iota ion of stem in relation to wells, buildings, etc., can be pla on reverse ide]. s�. FOR DEPARTMENT USE ONLY F _ APPLICATION ACCEPTED BY ry, _ . : :.:- ---- - DATE-------------- ------- --------------------------------- REVIEWED BY � DATE , Alterations and on recommendations:____-____.------------------------- --------`-------------- BUILDING PERMIT ISSUED.............. • --- - --- •• ------------------•-------•----------------- --------------- ---------- { --+--_-------- ---- ------------------ ---------.-----------------------------------------------••------- ------- -------------- -- ----------------- ---------- --------------- 11 ----------------------------------------- ----•-------------- - - --• ------------------- - ------------------------ • l -------- -------------------------- ------------------- __________ _ U __'�✓rl�.. _ - Dater------------- ---_----- -I-- _ .-' v FINAL-INSPECTION-'gY-----=._-�- ----.r---"=-=`--- ------=-----=----•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South Ameeican Street Trat California Stockton, California Lodi, California Manteca, California Y� FS-9-2M : ' Ravised W-210E1