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APPLICATION FOR SANITATION PeKiv.... o.r+ No. ------- <br /> -v (se (Complete in Duplicate) <br /> Date Issued ___Tata <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Orclinance.No'. 549. <br /> 7.- <br /> JOB ADDRESS AND CATION---- _ - ------ ------------ ----------------------------------- <br /> Owner's Name-- ....................................................... Phone----------=-------------------- <br /> Address <br /> hone----------:--------------------Address----------------------------- ------------------------------------------------------------ --------------------------------------....... <br /> Contractor's Name-.. <br /> ------------------------- ....................................­_ Phone.............................- - -- - <br /> Installation <br /> will serve: Residence j(.1 Apartment House C] Commercial E] Trailer Court E] Motel [3. Other- <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ..------ Lot size .... .. <br /> ------:------------------------------------- ----- <br /> Water Supply. Public'.system` E]Community system Private [] Depth to Water Tablei'3_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [j 'Sandy Loam E] '�C;ay Loam 0 Clay E] Adobe E] Hardpan T-]`"�'' <br /> Previous Application Made: Yes 0 No E] New Construction:-,Yes E] No E] FHA/VA-. Yes E] No E] <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) f <br /> i-A4 --...Materi <br /> Septic Tank: Distance from nearest well-S -------Distance frorn-foundeition--& --- <br /> No. of cbmpartnrienfs_p?---?rn-------------Size,1jPY_Y_" T-"Liquid d,pjh---- ---Capac y <br /> Disposal Feld: Disitanine from nearest e11 ---------- Distance to nearest lot line_______________- <br /> Distance from foundation <br /> Width of+rench.-- <br /> Number of lines........ Length of'each line-----------4- <br /> .-Depth of filter material-,/ <br /> length---------- <br /> x. <br /> Type of filter material <br /> P, <br /> Seepag.91pi Dist;_n -------- oe <br /> urn er of pits. -------------Lining material- am ------------------- <br /> Cesspool: Distance from nearest well__----------.-,--D;sfance -1rom, foundation......_.___.`.._...Lining Lining material.... .........I----------- <br /> I ! J- _ <br /> f_1 Size. -----------------------Depth----------------------- .......................Liquid Capacity----------------------------gals. i <br /> Privy: D;,sf6nce from:nearesf .......---------- ------............................ <br /> El Disfance-to nearest-lot -—-----------—---------------------------------I---------------- .................. <br /> ....................... <br /> Remodelingand/or repa!ring-(clescr;be):------ -----------------= ------------•-----------•----•-••----•••.............•...----------------------------------------------------- <br /> -------------------------------------11--, --------------------------------;--------------------------------------------------- .... ... ..... ------------------------------------------------- ---------_------- <br /> . ......................................e•_:•------------------------------------------------ --------­-------------- <br /> -- ...................._.._-._.. ._....--•-•.._..... ----------------------------------------- ---------------------- -----------------_----------- <br /> ---- -------. ......I........:!�...................... .......------------------------------------------------------------------------------------------------:------------------------........................... <br /> I hereby certify That I havepreparedthis application and that the work will be done in accordance with San Joaquin County <br /> ordinance�P, ff law <br /> laws, and rules and regulations of the San Joaquin Local Health District. <br /> _ <br /> ..... ....... <br /> (Signed) ...... lwlae- <br /> --- -- --------------------=-------------------------------------------- • --------­------------------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------­___........:----------------------------------------------- ------(Tlifle)-------------.......... ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__:....._... DATE............ --------------------- <br /> -- --- ------- <br /> - --------- <br /> ---------- <br /> REVIEWED BY----------------------------------- ---------- -----------------­­--------------- DATE.... .......... <br /> v -------------------- <br /> ---------------------- -------------------------- <br /> BUILDING PERMIT ISSUED...._..................... DATE------- <br /> / - ---------------•-•------------------------- <br /> 11_1�---------------------------------------------------- <br /> V. <br /> -- ---- -----------------------—------------------------------------- <br /> Alferatio d/ ommendaf ions:--------- -------- ......... ---------- ------------------- ------ <br /> ps and/ recommendations---------- .....I <br /> ---------------------------­--------- <br /> -------_------- <br /> ---------- <br /> ...................... ................................... <br /> e. <br /> --------- .�_6 ----------------ir----e,--............... -- ----------------------- <br /> ------------------------------------------------- <br /> ---------------------------------- ............. ------ ........ ----------------------I-----------------j <br /> FINAL INSPECTION BY:, 17;&�p------- Date, g-� 77 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C"Street <br /> Stockton, California Lodi, California MantaGa, California Tracy, California <br /> ES­9-21M - - Revised l-57F.P,C0. <br />