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XOO'dATION FOR SANITATION PERMIT Permit No.�--- (Complete in Duplicate) Date f5sued --- '__ -` `--5 Applica+ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 4:Q Owner's Name 9 ---------- ------------------------------------------------------ ----------------------- -----Ij................ 4 Address.......... % . ...jj�..................-- -- ------------------------ ------- ------ - Phone------------ ------------------------ ------------------------------------------------------------------------------------------------------ Contractor's Name_.__--f—I , --- r-----------r-------- W----------------------A------------------------ ---------------- Phone__Ftp 6"L96- Installation will serve: Residence (Apartment House 0 Corn r�e�r�cl alr Number of living J Trailer Court -0-7 El Motel El Other E] g units: I--- Number of be drooms ___Z Number of baths --- Lot size ---41ro Wafer Supply: Public system 4;L Community system D Private ❑ Depth 'to Wafer Table 40 ft. Character of soil to a depth of 3 feet** Sand El Gravel [D Sandy Loam F] Clay Loam E] Clay El AdobeHard Previous Application Made: Yes El No El New Construction: Yes gft__No E] j@� pan E] TYPE OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we�I�Ivrv.Disfance from foundation--- No. of compartments_---- ------- Size__63--y-4,16-----Liquid dep�-h-.Material--:7-- -----_4 --------------- Capacity---Polcir ------------ - - --------- Disposal Field: Distance from nearest well../V,0152�stance from foundafion____,_:)�P ._/---Distance to nearest lot line Number of lines--------- Length of each line------- ------Width of trench-. 24- Seepage Pit: Type of filter material----4'-�_;;��r[Depfh of fi)fer material--__.f- length-----;zjj.!� --------- Distance to nearest well_._,XZ'0-?_�_ _Disfance from fqunc1af'ion____240___' ---------------- ------ _.Disfance to nearest lot Number -----------Lining maferial_e__9%ff41! e11e. Diameter__.-_ Depfh _,—Z,_5------------------- Cesspool: Distance from nearest well_______________ __Distance from foundation___-_.___"_---_- Lining material_-____.-_----_---_--""- Size: Diameter---- -------------- _.Depth------- -----------------.......... -------- -------------—-------------------- --- -----Liquid Capacity-.------ Privy: Distance f:rio7mnearest well. ------ t ---______-_Distance from nearest building------- El Distance to nearest lot line --- -- ------------------ ----------------- ------------------------------------------------------- --------------------------------------------------- Remodeling and/or repairing (clescribe):------ ------------------ ------------------------r--------------------------------------------------- -------- ----------------------------------------------------I----------------- -------- -------------------------------------------------- -------------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------7-------------_----------- -----------------------------------I--------------------------------------------------------- ------------------------•-------------------••---•------ ------------------------I-------------------------------- - ------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Ipo"d rules and regulations of the San Joaquin Local Health District. 0 (Signed}----_-, -- - --- - ----------------- • By_ ............ ---------- ---------------------------------------------- ----------- ----_(Owner and/or Contractor) Z ------ `2! (Title)...... & (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 Ti ————�--`— APPLIC-A'fiON ACCEPTED BY---- REVIEWEDBY ---------- ----- -- --------- ----------------------------*-------------------- DATE-------- -------------------------------------------- --------- --- --- --- -------------------------------------------------------- ----- -DATE BUILDING PERMIT ISSUED-----------------_- _:-, ., -- ------ ------------------ ----------------- --------------- DATE------------ ------------- -- Alterations and/or recommendations:. ........ ------------------------------------- ------------ ------ - ---- ---- -- -- --------------- -------- R__ - -- ----------- --- ------ -----------------------------------------!........ . ---------------------- -------- --- -•- --------- - -- -- ------�; -_, f--------- �5------------------------ - ---------•------ -- --------------- ----------------------- ---- --------------- ----- ---------------- --------------I------- ---------------- ----------------------- ---------------- ----------------- ------------------------ ------ ---- --- --- -- ------ ----- - -------- -- ------------- a- --- --------------------------------------- ------------------- ---------- -- --------- --- T�' ---------------------------- -------- ------------- -------------------------- -------------------------------------------------- ------------------------- -------------------- FINAL INSPECTION BY----------------_---C� -------------------------------------------- Date----- -�- --�-- --- �--•- - - -------- SAN ate------ SAN JOAQUIN LOCAL HEALTH DISTRICT 13D South American Street 300 West Oak Street 132 Sycamore Street 914 North "C', Street Sfack+on, California Lodi, California -Manteca..California Trocy, California E.9-9 t45446 ATWoDa