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APPLICATION FOR SANITATION PERMIT Permit No. ............ I [Complete in Du licate p � Date issued.----•----•--•--- ------ +ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. Applica Y 5 This application is made in compliance with County Ordinance No. _ak ----------•------------------ -.`--- - JOB ADDRESS AND LOCATION-------- -f Phone.----------------------------- AF, Owner's Name-------- - _ _. •--• ••-----------------•------ , Address P� 3 = l r,� �� R -=-- 5-- ---•- • � Phone----------------------------------- Address Name--•--•-- .,�1_.�_�-2__-S_f�-------- J �'l-C-t-------------------------- ----------------------- Motbl Other ❑ 4 ar#ment House ❑ Commercial ❑ Trailer Court C]Installation will serve: Residence �, Ap 45r-1,31-10-0-1--------------------------- Number of living units: _1--- Number of bedrooms ___/.- Number of baths __1___ Lot size ___ ❑. _D_6 th'to'Wate Table"A_- ft- —1 —".1 Water Supply: Public system []Community system Privafa p ClayLoam [I Clay ❑ Adobe 0—Har dpan C]Character of soil to a depth of 3 feet:-Sand ❑ Gravel ❑ Sandy Loam ❑ { ew Construction: Yes 19--No 171 Previous Application Made: Yes F1 No (�N 1 TYPE OF INSTALLATION AND SPEC IFICATIONSs j I (No septic tank or cesspool permitted if public sewer is available within 204 feet. .. 0 X........ ! Septic T k: Distance from nearest we{I_ ]1a u, Distance from fousdation__../ __-...-__.Mate-: -:Capacity____ F 3� OG Liquid cle th No. of compartments_...-_.f-w.4?....... Size.!_-�`-------•-- -•-------- p. , ` ... 4 s Disposal Field- Distance from �ea�est well_.��-!�-!'Distance from_foundation______-�-.�- -�r Dista.ce,;to nearest I� line_r--��-°�- Number of lines-c__-__-------1 1. -----Length of each line----- --------J---,.`----Widih of trench---------- -- = = - y 3 p vial . To#al length___----- ------•------------ Type of filter material__-1-_ -- R.-De th of Dis#ante to nearest well--- =~Di nce from Tbundati n__..1---------f. Distan c to nearest lot line__ ----_--- p , Seepage �it Number of its------ ---------- Lining m terial__; !'-� .Siz : Diameter--._ .-----._.'_De fin_.-.__ ---------------- p _ ____ ____________ Distance from nearest well_________________ ce from f anon..,-- Liquid Capaci} ----------------------gals. Cesspool: -, q p Y•---�----•-------------=� ❑ Size: Diameter_: ------------------ Depth-------------=------ ---------- -- - -- ' ' �-'-' Distance from nearest buildimi---------------------------------------- Privy: .. Distance from ..�..-nearest well-------------------- .,,�. ... r - _ . ._ ,..... . - ----- ---•------------ ---- --- ❑ Distance to neare t:.lot line------------------------------ •--------- S_.Tilt -----••--••--------------- y Remodeling and/or repairing (describe):-------- 4eto------------' — : ---------------•--- ---------•--- k •------------------------- ------------- I herebycertify that I have prepared-this application and-that the work: in accordance with Sail Joaquin:County _ ___ g ordinances, State I , and rules and regulations of�the SaRJoaquin Local Health District. i - --- [Ow and/or Contractor --- -- ---,!✓C ---- 2 --`---------- (Signed)------------- -- --------• .. (Title)--: --- - -------- By:_-------------- - ---------•� �•�` [ [Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U-SE ONLY iDATE------�-------- --- --- ----------------- APPLICATION ACCEPTED BY ------------- -•---------------- - .DATE -- REVIEWEDBY------------------------------------- ------- --- - •------------ DATE_.-------- --------1------- --------- BUILDINGPERMIT ISSUED._.__..__.. .-------•------- ------- -------- --------- - ...__..--------- --------------- ---- ----------- ----- ---: Alterations and/or recommendations:------------- -------- •------------------------ -----..----_-------------- �- ----- ------ -------------------------------------- - ----------I---------- ------------------ --------------------- ----------- -----• ------------------------------ Y l c Date.. --- FINAL INSPECTION- :.----- --- --•--• - .- ----- -----•--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT +h "C" Street North 132 Sycamore Street 814 Nor 130 South American Street 300 West Oak Street 7rCalifornia Lodi, California Manteca, California ' Stockton, California , ES-9 , 5n 6 wT-DCD