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I ��77 ��77++��ii APPLICATION FOR SANITATION PERMIT Permit No. ...!_L_CJ___M---_. (Complete in Duplicate) 1 Date Issued District for ermit:to construct and install the work herein described. Applica{ion is hereby made to the,�San�Joaquin Local Health D p This a plication is made in compliahce with County Ordinance No. 544. i v {�2i 3 A Got c Ems':. Al . ')S— D sD LOJOB ADDRESS AND -------------------------------------------------------- Owner's if ------------ Owner s Name.--- ....... i -------- -- --- -------- ----------- ---- ----------- - ----._ Phone.--------- -�---o--- ---------- �. . ------ Address----- --��... f - -- ---------------•-------------------------•--------------------------•-----------------•--------------- Contractor's Name----------------------- -------------------------- ------------------- ------------------------------ ------ Phone--------..-..--------------------- I Installation will serve: Residence.T] Apartment House ❑ Commercial ❑ Trailer Court E] Motel [I Other ❑' N Number of living units: 1_4 Number of bedrooms --fZ-.- Number of baths /----- Lot size _--- '-`'ct ------------------------------------ V1j > ' Water Supply: Public system ❑ Community system ❑ Private-[] Depth to Water Table d _ ft. Character of soil to a depth of 3 feet: Sand [–] Gravel F] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan I Previous Application Made: Yes ® No ® New Construction: Yes ❑ No, ] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted if public sewer is available within 200 feet.) 3 Septic Tank: Distance from!nearest well-----------------Distance from foundation--._-__.----------.Material-_-----..----_._---.-_---..-._---.---_--------_. f No. of compartments--==-------- - ----------Size-------------------- ------.Liquid depth.-------- -- ---- --------Capacity----------------------- El Disposal Field: Distance from hnearesJt well..--------Distance from foundation,'--7D__-------.Distance to nearest lot I��e-- ----------- i Number of IiAs-----.l----- Length.of each line--/.- _-__ Width of trench-.-.- --------------------- ,� r----- • . Type of filter material./&.. Depth of filter material-- _ .:- ___.-Total length___14m--------------------__..---- Seepage Pit: Distance to nearest well....------ ---__-Distance from foundation-_=..-.-----------.Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size:Diameter----.-..---------------Depth--------------------------_--_-- Cesspool- Distance from nearest well-----------------Distance from foundation--__-_-.--..-__----.Lining material--.---..._-.----.------.------- ❑ Size: Diameter------------------------------------ -Depth----------------------------- -------------- Liquid Capacity--.---------------------------gals, Il. --Distance from•nearestYbuildin '" ----I 9 �^ Privy: Distance to nearest lot line__-.-.___----------------- -------- -- - X Distance :rom,;nearest we __--_._�--_-�-�.___--._..--_. Remodeling and/or repairing (decribe):_.--- ;_ ,r--- � y�'� IM ------------_/ ....E-----•--------------- ------------------- ---------------------------------------------------- --------------------------------------------------------- i -'I�- '-----------------------------•'--- ---•-•-•---__-_---------------.------------------------------------------------------------------------ h ---------------- ----------------- ----------- ---------------•---_-------__--...-_____---_---_-_-•.------_-----'-- ------__•-----------------_-__--_-----.._---._---------__----•--------------•------------'.-.--------- I hereby certify that I have prepared this application and that t o work will be done in accordance with San Joaquin County ordinances, State laws, and rules land regulations of the San Joaquin Local Health District. d � ----------------------------------------------------------------------------(Ownerand/or Contractor(Signe -----------------•---------•-•------------------- •----{Title)---------------------------------- k (Plot plan, showing size of lot, loci tion of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__�; r'�-,�'�'�� -- ----- -------------------- ------ DATE____, -`-/ --� ---------------------------- REVIIWEDBY DATE------------------------------------------------------------ BUILDING - Alterations and/or recommend--- ------------------------ -•--------- --------------------------------------------------- DATE------------------------------ ----- -------- -------------- ----•---------------- ----- -- ---------- ----------------- ---------- j� - ' BUILDING PERMIT ISSUED-_--_ recommendations:------------- ----------- ----------- - / { -------- I� `"' r ` ----------------------- - • '"�-- �"+' !„rr= ° •-✓ rt�7 - - ---- .�'"'a�' ^' - ------- ••----- --•- - -- _ ..... ' p <:_ k _ - ---- Ii --- ---- ----------- yJ 6F FINALINS ECTION BY:.. ----- ----------------------- - ---------------- Date--- 7-- --------------------------------•--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stoektort, California Lodi, California Manteca, California Tracy, .California ES-9 145446 A-/'WtlO� f^ � ' .ii+'t+.. � � '��•.rr•ri"� .—. � .; a.j'+ °IAF: