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1 -7,1 -� ---- a APPLICATION FOR SANITATION PERMIT Permit No. -__-Cr". - .... (Complete in Duplicate) Date Issued Application 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 Countyrdinance No. 549. JOB ADDRESS AND L CA ON_____1_ -- Owner's Name__-- ---:-"----- - --' Address-------- ----------------- -----------•------------------------- - --------- ._ ------------••------.... � �Contractor's Name------- � Phone_ Installation will serve: " Residence [] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other clrge Number of living units: -------- Number of bedrooms _______ Number o aths -------- Lot size ______ Water Supply: Public system C❑ Community system ❑ Private Depth to Wafer Table i ft. Character of soil to a'depth of 3 feet: Sand Gravel ❑ Sandy Loam lay Loam Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ❑ No New Consf ruction. Yes Rr No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w { (No septic tank or'cesspool permi+ted if pubiic`sewer is available within 200 feet.) i Septic T Distance from nearest well-*.Q___�.,Distance from foundation__. ---------Material_________________ _ _""--__" No. of com arfinents_. 'i �t a p .�+. Size- ------ --4--Liquid depth""�8------------Capacity-- ' ----------- JV-0 Disposal Id: Distance from nearest well ------Distance' from foundation__I__�--*-----Distance to nearest lot line-____ 4O ' Number of lines-----J. -------------:_--Length of each line----�`+a--t___""_ """--_Width of trench---�"-V�!-------------- ----------- Se --------"""-.- t Type of filter material_ ,_d1,__t"---Depth of filter material____._/ �______Total length___---LOo'---" Seepag if; Distance to,nearest well___NP!--_--___Distance from foundation__. fline-- Number " sit . � �u]--__ __..Distance to�nearest lot of pits_--_I--------_______Linin material___ it i Cess ool: .g -- -------Size: Diameter--e�_�__g__---"--.Depth-------��------- ---•--- P Distance from nearest well------------------ from foundation__________________ Lignin material --___-_____-.---------_---_- ❑ Size. Diameter-- -------- -- - ------De th------- --- -- - ---------Li uid Capacity - - - -------gals. Privy: Distance to nearest well ".__ ------------------------------------- Distance from nearest building---------------------------- t� Y� Distance from n � 9-------------------• --=----- ------------ oest lot line_______________________ ------------------ - _ __ ---------------------------------------=--------- Remodeli g and/or repairing fdescrib _ rt • . `- ---- - ---- F ..� -------------- ----------- ----------- ------------------=-----"--------------------/----------------------------------------------------------------------------------------------------------------------------hereby certify that I have pre4 pared this application.and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules apndd regulations of the San Joaquin Local Health District,' (Signed) f�` CA•4 �_14. (Title} ------------------------- - ------------------------- By:-- -------------- `= Contractor) (Plot plan, showing size of lot,'locatic�n of system in relatic, o wells, buil Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED . -------- ------------------------------------------------------ ----------- ------ DATE----q= --- �--5REVIEWED BY-------------------------------------=s-- _.--------- ---- ----------- - -- ------- DATE--------------- --------- • -- --------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------- ------------------------------------ # •- ------------------------ ------------- --------- DATE and/or recommendatons_ ................................. "`-" """"~--". -• ----------------- -----•--------------------------------•----•- ----------------------- rw I;tom ST m is_._.A_P Rov_ FOp, 1'nt�T---- �1 �--rl•-! G'/� � 4 �M �- -- �p -"--. V51T---- 3A=------- _.�_"Y ' -------------------------------- -FINAL INSPECTION' BY: � - �------ --- ---- - ---=- - - -- � Date.------ ---~ -- - ---- ---- ------- -'--------------------------------- 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 i• ES-9-2M Revisea 1-57 FRCO.