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APPLICATION FOR SANITATION PERMIT Permit No. .__ 9 ..5 (Complete in Duplicate) t Date Issued V Applica{ion is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. . This application is made in compliance with County Ordinance No. 549. •y�v7fj: Zj --5 0 -a-Y M JOB ADDRESS AN_Q LOCATION... ... - ------------------------------------------------------------- } _ ------------------- Owner's Name----- --- ---_-------!`� • ------- ----------------- ------------------------------------------- ----- -------- ----------------------------------------------------------------------- Address — Phone =Contractor's Name----+------------- eC Installation J +� will serve: Residence K A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �❑ Number of living units: ___1__-- Number of bedrooms __- umber of baths -/--- Lot`size ---Zq__, , __ r -��"--------------__________ Water Supply: Publict,system ❑ Community system ❑ Private 9 Depth to Water Tablet_-6__ ft. Character of soil to a(depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam❑ Clay ❑ Adobe)A Hardpan El Previous Application Made: Yes ❑ No . New Construction: Yes xNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__;6_0_4'Distan e from foundation___ _ _ ___ _. teriai No. of compartments- - - - -r`�►.�----------Size_ r - ---- - Liquid de th_1 _.------f 'dlS :t}i'----, - -6 - - Disposal Field: Distance from nearest well-/.0.&+Distance from foundation__1_1.,`.____.Distance to nearest lot line____. r _ Number of lines----------I-------------------,.._Length of each line------ Width of french...�_,- ----------------------- Type _ _Type of filter material_ Q._Depth of filter material_____ _-_ 1�__-Total length------- .,(_��0?___________________ J { Seepage Pit: Distance to nearest well._-_-; '-'_Distance from fo ndation__,__ ____-_.9is ce to nearest lot line____ . CD In Numbe� of pits------)---------- . ,e is ize: Diamete7_ _ .t t:�. P 4.h- - ---�3�-- --- Cesspool: Distance from nearest well_____ .-.--- istance from foundation___________________Lining` material---------...------------------------- Diameter-•-----.- - --- Depth Liquid�Capa_ city als._ :�--`�"t'-- � •,.� _. --a..-c ter..-..� - .. --.-�- ..�. ., ,.�,- ..�._-�' �" -y�,i: - - _"'----ti..-'f A ... ,. - Privy: Distance from nearest w011_:-------------- _-_-____-.------ --------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--- ------------ ----------- ------------------•-------------------------------------------------------------------------------------------- J Remodeling and/or repairin,6 (describe):_-_J (,?--- ---- ----. ��"� --- -- --- ------ -- ----"-- " ""---- f i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S.. ate laws, and rules and regulations of the San Joaquin Local Health District. 5i neda,�4/ - i ---- - - ----- --- ------------ - -- = (Owner and/or Contractor) ( g } � _ -- i SY= -----=--- ------------------------=-- (Title)---- ---------------------------------------- ----------------- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .r APPLICATION ACCEPTED BY - ----------------------------------- DATE ------------------ REVIEWEDBY-------- -------------------------------------- -------- --- ----- - --- DATE-- �---�-�---�------------------------------------ BUILDING PERMIT ISSUED---------------------------------- �[ - ------ ---------------------- DATE - IVA Alterations and/or recommendations:_-___-4------------------ _ _ T ;_ ------------- --------------------- -----------------------------------------•------------------ ---------------•-••--•----------------------------- --------------------------------------------------------......... ------- ---------- LL FINAL INSPECTION BY:.--- Date-- -------"7___-✓- �-- -------" ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California 'r!�`� Manteca, California Tracy, California., Es-9-21A 145446 ATW00D ,z