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''tib•. , q ii ,, � 01151 "bl{ ' " '• ;' Pm.it N4. �� , °� 7 APPLICATION FOR SANITATION-PERMIT- e . I (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described I This application is made in compliance with,County Ordinance N 549. JOB ADDRESS AND LOCATION------------ -- ------ - r Owner's Named-- ----- -- - •---- --------- --------------------------------------------- Pho e g Address--------- 1 ` Contractor's N � - ------- ---------------------------------------- -•----- ---- --------- ly 4 'f - Name----------- ----- --- -- ------------ - ----------------------- ---• ----------- Phone. Installation;,will serve:7„Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel # Otherf❑ f/3f n — ... rfr IN mbar of-living anifs:-'__.'"Nu-m�—.--ber of bedr-ooms�_ 'y Number of baths _ ,� �,- --_ - '= __ Lot size _-_ _ Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table-gV-O ft, Character of soil to a depth:of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: ;Yes ❑ N0 - New Construction: Ye No ❑ FHA/VA: Yes [_1No f� „E,r I fi TYPE OF INSTALLATION AND SPECIFICATIONS: h (No septic tank or'cesspool permitted if publiecsewer is available within 200 feet.) SepticLTank: Distance from nearest wall_ Distance from foundation___________________Material.. ---------------------------------- No. of compartments_' _ -------- -_Size--------------------------------Liquid de th----------------------------------------- Ca aci Disposal ieid': Dis#ance,fromi'nearest well _______________Distance from foundation___________________.Distance to nearest lot line______________. a Number of-lines_- `_�m-----------------Length of each line------------------------------Width of trench.---------------------•------ ___-- ' T -- Total length - Type of�filter,material____---__---_ ____-Depth of filter ma#erial___.________ g __________._ 4 YP Seep e Pit: Distanc�to nearest welf___/ _ _...______Distance from f dation 940 stance to nearest lot I ____ � ( NNumberof Pits a e Lining mate Diter Depth- , Cesspool: Disfance from nearest well_________________Distance romfoundation.__________________.Lining ma#serial------------------------------------- El __._..___________________.______ __❑ ¢e:'Diameter------------------------------ ---------Depth-------------------------------------------------.-Liquid Capacity---.- --gaI ______________________________Distance from nearest building _-______.___.____- Privy: Distance from nearest wall-___---________ __ • i ---------------------------------------------------- i Distance:to nearest lot line--------------- ---------------------------- - -----------•---•----------------- - Remodelin and d/or repairing (describe):_-- =- j - -____-- -- _ ---------- - --------------- --- ------------- - `�s � --- 0 - z ---- ---------- ._..) = ------ ------------- hereb certif that�l Have---------------------------------------------------------------------------------p--:-------------;:--•.--------------------------.------•-•---------; Y� Y P P PP qui re aced this a lication nd the he work`wili be done 1n accordance with San Joaquin County ordinances, State laws, fid rule nd ulations o the n Joa n Local Health District. ,t � (Signed r =/ " ----- ---------------(Owner and o -Contractor) Y• -----------`- ... -------------------- "=�� ---. ` B ' rTitle); Plot len, showin s e�of to '- ( p g , location of system in relation to wells, bwldings,-etc., can' be pi onreverse side �4 FOR DEPARTMENT USE ONLY { ` APPLICATION ACCEPTED BY------------------------- - ------------- ----- --------------------------'_ DATE----------- i - - '--- - -- -- - 7 i REVIEWED BY---------------------`'-- ----- -------------- DATE _. - BUILDING PERMIT ISSUED-- ----------------------------- ;� DATE._ ----- ------ Alterations ---- Alterations and/or recomme da`tions:-------"----------------------------------------------------------------------------k------•--------•----------------------------------- '=-=--------•--- -----------------------------------------------•---------------------------------------------------------------------------------------------------- ------•----•---- ;l -----------------------------------------------=- ------•----------------------------------------- --- ------- i •---- ------=----------- ----- --------- ------------------------- --------------- --- - ----- -- ----- ------ -1------•-------•-- ----- '----------- - `-- - -- II � - FINAL INSPECTI ' � _-- -- --------------- ------- Date----- �'--�-y--- - SAN JOAQUIN LOCAL HEALTH DISTRICT /f 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 Ravisea 1.57 4.P,CO. d J