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4. APPLICATION FOR SANITATION PERMIT Permit No. 7_--.... (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Healt District for a permit to construct and install the work herein described: This application.is made in compliance with County Ordina e No 1 JOB ADDRESS AND LOC TION___. _____.____. . -_.. I Owner's Name it ��y,ls --------"- Pho - Address-------� .----- ----.- F Contractor's Name-------------- _ -------------------------------------------------- ----- -----._. Phone-------"?X2 ' ' Installation will serve: Resi enceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �`------ Number of bedrooms Number of baths _/-__- Lot size -------------------------- Water Supply: Public system Community system ❑ Private E] Depth to Water Tableeft. Character of sail to a depth of 3 feet: Sand L] Gravel E] Sandy Loam F] Clay Loam ❑ Clay E] Adobes Hardpan ❑ Previous Application Made: Yes E] No',® New Construction: YeA No ❑ ! y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) K"Ieptic Tan Distance from nearest well --------------Distance from foundation__.-----------------Material--------------------------._______.__._________-- No. of compartments-,.-----------------------Size--------------------------------Liquid depth--- ---------------Capacity----------------------- isposal F' Id: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line--------- • Number of lines,----------------------------------Length of each line---------------------------.-.Width of trench---------------------------------- - { Type of filter material________________________Depth of filter material-----------------------Total length___.__________________._-_ Seepage Pit: Distance•to nearest wefj._ _Distance f m fo dation ------Distance to nearest lot line_,__ .e Number of its____ ________________Linin material _ Si i i�- p g maize: iometer Depth I Cesspool: Distance from nearest we€I-----------------Distance from foundation.............__. Lining material__._____..____.___-----_._____.____-- ! Size: Diameter--------------------------------------De th_.-_----------------__ _ ----- _ _ __ - -__ _ Liquid Capacity ❑ p - - - - - - - ------- q -------------- -------------gals. \ Privy: Distance from nearest well----___----------- -----------------------------Distance from nearest building-----.-------..._-__ ❑ Distance to nearest lot line------ ---------- ------------ _ ------------ ------------------ -- ------------------------ Remodeling a r firing (describe -f�r� �� "----------- .T -_ ,� -- .�___________________________________________________________________________________________________________•___.-.___-___.________._____--___.--..._-________-.--______________.._ - -------- ------- ............ -------------------------I., ________________________..-________________..__.______._-__________-________--------- hereby certify that 1 have repared this application and that the work will be done in accordance with San Joaquin County o inances, St ws, an rul and regulations of the San Joaquin Local Health District. :: -- ----- ------- -------- - ------ ----------------------- (Signed)------ - �� ------------------------------ - - --- (Owner dor Contractor iBy:------------------ - ------------' --------------------=------------------------ -------------•------------------------{Title ------ r (Plot plan, showing s' of lot, location of system in relation to wells, buildings, etc., can be p aced on revers side 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - ----------------------------------------------------- DAT "5 ---- ----------- ------------------------- REVIEWED BY----------------------------- ----------------------------------------------------- -----•----------------------- DATE- BUILDING PERMIT ISSUED------------------------------------------------------ ----- DATE......erx--------------- I Alterations and/or recommendations--------------------------------------- --------•----•---------------------------------------- \------••----------------------- ...- I -- --- ----------------------- '_-= - -- ----------- -•------ . "Q.--cy, ----------------------------------------------- --------- --•----------------- -----------•--------------------------------------------------- 1 --------------------------------------------------------------- ------- -- - ----- FINAL INSPECTION BY:- - - ------------------------------- Date--------------------- - ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street . IIr`eyk, Stoekton,'California Lodi, California Manteca, California Tracy, California -" t" E5-9'-2M 145446 A7W0CD 12.54 4