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JAI P_2, APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ____ L'f 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 County OrdinanceW. 549 JOB ADDRESS AND LOC ATI0yW__ _+ ------- !------ -4 ;4 d6~-------A..4-0--- - ------------------*-----t----------------------------------------- Owner's Name ` -I 'Phone _ 0 --- - ------------------------------------ Address--------------z4g;__//a------ -- - ------------------------------------------------------------------------------------------------------------------------ -------------- ..;r -------------- Phone------------------------- Contractor's Name-____________ --- -- - - - - - -- -------------------------------------------------------------------- .--- Installation will serve: Residence �Aparfm' ent House E] Commercial 0 Trailer Couft,E] Motel E] Other [_1 Number of living units: It.- N ber of bedrooms -An-Number of baths --- Lot size ------------------ Water,Supply: Public system Community system Private F F Depth to Wafer Table 30 ft.I Character of soil to a depth of 3 feet: Sand El Gravel F1 Sandy Loam [I Clay Loam El Clay El Adobe Aronarclpan,[-] Previous Application Made: Yes El No WNew' Consfruction: Yes Ego011o E] FHA/VA: Yes F1 No 94-- TYPE OF INSTALLATION AND SPECIFICATIONS: liz% (No septic tank*or'cesspo'ol permitted if public sewer is available within 200 feet.) a---- 11 -----Distance f n___-A0--------Mate -------------- Septic Tank: Distance from nearest w "---- ------- jonn founclafio No. of compartm ;L `--------Size_ ---Size- _460---Liquid depth____,k_ ---------Ca pa city-- _Jojp� iR000 ---------- X_ lin Disposal Field: Distance,from' nearest welf______r:., Distance from foundaflw__/0_!�----Distance to nearest lot line____ o f Num lines_________-_____r____ do W0001, Number of lines--- f each line`__ --------Width of french... --------------- - Type of filter mate'rial/_Z_A epth of filter ----Total length---------ZIP_------------------ Seepage Pit: Distance to nearest well------wm��------Distance f om fo Hation---- Distance to nearest lot line--- ----- - epth_----—------#---------- W041 Number of pifs....../-------- ----Lining material_ Size: Diameter--- %r-------.D Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__:__---_---__-.___________.______--. Size: Diameter--------------------- ---------Dopfh_---------16%=--------- -- ------Liquid Capacity----------------------------gals. Privy; Distance from nearest well--------------------------------------------------Disfance from nearest building_._._.------_____________________------.-. ----------------------- - - -- El Distance to nearest lot line---------------------- - - ---------- -------------- - ------------------------------------------------------------------------------ Remodeling and/or repairing (describe):------------------ ----------------- - ------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------------------ ---------------------------- --------------*--------------------------------------- ------------------ ---------------------------------------------------------------------------I----------------------------------------------------------w�------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------- lication and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this app ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. tor---------------------------------*_"(Qwx*wmaAV." Con-ft-actor) (Signed -----------------04 ------ By_------------------ -_-------------------_ 04—--------------------------------{Title)--- (Plot plan, showing size of lot, locatip,tsys+erri ------------ relation to wells buildings, efc., can placed on reverse side). FOR DEPARTMENT USE.ONLY C7 APPLICATION ACCEPTED BY------ -------------------------- ---------------------------------------- DATE ;;O�------------------------- REVIEWED BY-------------------------------- - ------------------------------------------------------- DATE------ ----------------------------------------------------- - - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recoPmmendatms--------- -------------------------------2-- --5----------I-_----------------- ----------------- --I-------------6----7--._-.-.t---gn-- ------------------------------------------------ -------------------- 5------------------------------------------------------------------- ------------------------------- I-T-7---12F-PT-14 -----------------------------------------------------------------I------------------- ---------------- --------------------- ----------- -- ----------------------------------------- ---------- ------------------------------------�70XKs...... L:F—_A_C9-------- 1 -------------0 -.K---------Ft-:R= --------- -- ----- ------------------------- ------------- ----- ------------ ---- ----- -- - -------------- -- --------------------------------------------------------------------------- Date---- ----- -- - -------- ---------------------------------- - FINAL INSPECT -- ------- 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.PCO.