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APPLICATION FOR SANITATION-PERMVt- Permit No. ._ �_ S (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Haltht,for;5pZ rrto construe 'and install the work herein desc i4ed. This application is made in compliance with County a No. 549. .E V 4� JOB ADDRESS AND LOCATIONd - , - -. � �� _ ) '•• •--------------- Owner's Name &,A_ - -------------- Phone Address------------------ s .. ------------- ----- = - --------------------------------- J' Contractor's Name__. -----•------ - -- - - •---------------------- -- one _ Ph Installation will serve: 'Residence Apartment House C49mmercial ❑ Trailer Court ❑ M t� 1-1 Other ❑ Number of living units: umber of bedrooms _-!_"'Number of baths .-/--:_ Lot size ---6_ " `Y:-X----'_ Water Supply: Public system v "Community system ❑ ' •Private"[] Depth to Water Table -------- ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�_ Harclpan ❑^ I Previous Application Made: Yes E] No LTJ'0- New Construction:-Yes ['No ❑ FHA/VA: Yes ❑ No # TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or'cesspool permitted iyublic sewer is available within 280 feet.) r _ .�•� s Septic ank. Distance from nearest well_ j� Distance from foundation) __ __ _____. �ateriai_.__. - 4 ------------- PV .__... .� No. of compartments __._fit--------Size--------------------------------Liquid. e fb---1-------. Capacity-, a acit -- 4 ....m - — ti � .r +'.s!_ t Dispoyl'Field: Distance from nearest well-___ .!�ilt�,Lf Distance from'foundation htance to nearest lot lie 7�-G71/, F �. �- -----------= [ Number of lines----------- ------ -----------:_Length of each line-_---_--_-._. _ -----Width of trench------ Type of filter materi I_ ____ -__!�� . -{Depth of:filter material-------- Tota€ length____------.- ------------- _Q.._.. . Seeps Pit: Distance;to nearest well_______-�'__Distance rom foundation_--6I _Dist nee o nearest lot lin : S► f Number of pits---------I_-__-_--_.Lining material-_-�'_ ._ •_.Size: Diameter--------------------- p I Cesspool: Distance from nearest well----------------- from foundation.___... ------_-.Lining material.,__-_ r ❑ Size: Diameter-------:_� �-------__Depth--=•- __ - -_ "tr'...i iquidCapacitY ----------= ---------- M ___ �. Privy: _ Distancerifrorn nearest well'.=:. _:--".'--------------------------Distance from nearest building------------------------- Distance to nearest'lot line- ---` = +' --------------------- --------------::-------••----------------------------------------------- Rmodeling and/or reppiring„( lescribe)•-----------------------------------------------------------------------------------=----- ---- •----------•-•--------------..------•----- ------ __.--- -•--•-------------------•-"------------------=----•----------------------------------------------------------------------.-_-...i } i --------------------__--_--__-_____-_---..___-_.----__..----__----__-.-.----_---_-_-__-__---_______-._.__._----_.._-_-----i.-.-----------------------------------------------...-------.---------------------------------.______ I hereby certify that I have 4prepared i application and that'thek work will be done in accordance with San Joaquin County ordinances, Stite laws an rul'rr re I ions of t e San Joaquin Local Health District. Si ned __ Owner and/or Contractor -------------------(Title)-------------------------------------------------------- ------ (Plot plan, showing size of lot, location—of`system iii relation to w`eifs,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY-� ------------------ -------------------_------------------- DATE----------•-- ------------------------------------ 4�REVIEWED BY------------- :-------- ---- -------------------------------------- ------------------ DATE------•_--------------------------••--------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------........ --------------------------------- DATE.----- ------------------------------------------------ Alterationsand/or. recommendations:----------------------------- ------- ---------------------------------•-------------------•----••------------------------------------------•------•---------- - -- -------------------------------------------------------------- - ----------------------------- ------- --- -------� ------------------------•----•--------------------- ------------ ----_...__ .--- ,- J, �/ .__. __ __ _ ___ _----_ [/Jj FINAL INSPECTION BY:. .__-- o jr- " Date - ^/ `S 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 1.57 F.P.CO.