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APPLICATION FOR SANITATION PERMIT Permit No. _L 4_ -__--•- (Complete in Duplicate) Date Issued -------- Applica+ion is hereby made to the San'Joaquin,Local Health District for a permittoConstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. F ' JOB ADDRESS A LOCATI N:_Z_q_.. ._�___-_. Owners Name = -----------------------------, -------- -- -_ one�l_!--_1.Ud -Yl ----- - -- --- - 1 Address____ - Contractor's Name----- '--__- -• _ ---'__ ----- __ Phon __ Installation will serve: yResidence g--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_I Number of bedrooms _Y___- Number of baths ./___ Lot}size ___ ____ /LC-1.---____________________________ Water Supply: Publicfs -stem-. '"Co'mmunit s stem e Priyate a th to Wafer Table ft. ' Pp Y' Y :I Y Y ❑ P Iy Character of soil to a depth of 3 feet: _Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes Q No ]""'New Construction: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank.or cesspool permitted if public sewer is available within`200 feet.) Septic Tank: Distance fromnearest well.................._Distance from foundation_______________ .Material-----------------_---------------_____'--------- No'. _ -__-. No. of compartments____ Size..._.... .........:...Liquid death--------------------------Capacity ---- a fo �� isposal Field: Number of_lines::__`�___..- - ___ ' -Len th of'each line"__'_ ��, .Distance to nearest lot Iine____,��__'_. I r : r Distance�f=•om nearest ell L��_ Distance from foundation -- -� Width of french....��_�'____________________ Type os filter material.__ _ ______Depth of filter material.---__Z�:.�-----Total length___-__7.�-_-______________________ i i �'Number of: its-';_'__._=_°_' ��'~ Distance from foundation.......:.....:....pistance to neprest lot_line_____._ � Seepage Pit; Nu ante f. nearest'we" - Linin material__-______ Size:':Diameter------------------------De fn_---_---_-____-_______I_________ . ❑ pits g -- Cesspool: Distance from nearest weEl----.------- ___Distance from.foundafion t_ f __;Lining material________________________ _---------- 4 __ ____. - = _ ------ ---------- ----- �' als.El Sizo: Diameter De th= ' tLi uid Ca acitY---------------------- T_ Privy: Distance from:'nearest well_ _ ____--------. ( _:._Distance from nearest building __________ _________ F-1 -Distance ` ....«.... }fid,. Qistance to nearest lot line___."_____"4_.____ __.____. ""`___. ---_--------------------------------------------------- Remodelin9g and/or repairing .�des*cribe�:--- Il ..---•--.•--.---- . f ---------------------------- ----------- ----- ------- - -------•--•---•------------------------ _ ,. ------------------------------ ------ -------------- ------------------------"- ------ ---------------------------------------- ------ I hereby-cerfify that I have prepared this application and that the work will-be r done in accordance with San Joaquin County ordinances, St a law , and rul s and re ulations of the-San Joaquin Local Health District. (Signed) u, " " `.•-. (Owrrerwaad/or Contractor) l~ --- :� -------- F ------------------------ By:.....' �.-•••--•�- ----- --------------------�- ------.....-=------"-..---------------------(Title}--- -- -- - (Plot plan, showing size of lot, location of sysfem in relation to wells, buildings, etc--can be placed on reverse side). d� r FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY-- -- = DATE. `--=-----••--------------------------- REVIEWED BY ---- --- - - DATE ---- ------- `- BUILDING PERMIT ISSUED------------------------ - F ----- ------ DATE--------- =,�5``"°`°` �� Alterations and/or recommendations:___.t___-----------__--------------------------- -- - a t : I �-- s -----------------------------------------------------•-•-•--•- ---------- -----" -------------_1..--•--•-- ------------------------------------,---------------------------------------;------------------------------------- ---- "------ ---------•---------- _ k k ----------------------------------------------------------- --------- ---------------------------------------- ----------------------•----------------------------------•---------------------------------- - --------------- ----_.._. - � _ �� :,,�ssk�i aZ. — .S— FINAL• INSPECTION-BY:..--._._ ._...._ - ----- Date-------_.r7" __----- y r._.R SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100