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APPLICATION FO,.,, JANITATION PERMIT Permit No. (Complete in Duplicate) D 3 ate Issued Appficeion is hereby made to the San 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 LOCATI N____ l_2_!_ C. ----------- Owner's Y-- .�" Owners Name ---------------------------- ----------- -------- -- -- ------------------------ -------------- J' ------------- Addres .:: ..... ...:. �=-. id --- -- A. Contractor's Nami,...�._ .41 c ,-__ - --•------------------ ------------------------------------------------------------- ----------- Phone ---'-"----=�`�- A� ..,� - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ v� d _ } r Number of living unit: --- Number of bedrooms _�.: Number of-baths ._.Z Lot size __ Water Supply: Public system:❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth�lof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ i Previous Application Mader ,Yes ❑ No &New Construction: Yes &3"No ❑ e TYPE OF INSTALLATION`AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic. nk: Distancelfrom nearest well-----------------Distance from foundation-------------------- id dMaterialr ---------------------------------- ------ No. of compartments - ------------------Size---•---------------------------Liquepth---------- ---- Capacity f py----------------------- Disposal ield: Distancell from nearest well.................Distance from foundation____.....-----------Distance to nearest lot line.____..__________ c . Number V lines-----------------------------------Length of each line- Width of trench ------ --- .............:,-:_ ,. See a e t: Disancel to nearest well---��---___-- p � length------•------------------------•----__---- -_Distance from foundation---.._f+_...._... Qis# Type or��'filter material__.___._.._ - Depth of filter material Total nce to nearest I�F'lir _-_-�------• • w , ., f r . Dumber of pits----�----------s;---Lining material--=---------- -------Size: Diameter_--- ----�.-��-Depth--- Cesspool: eptn__,��-`-' Cesspool: Distance,from nearest well-----------------Distance from foundation_-_-_.._._:-------- Lining material__.__-,-.____._._._______._:-------------------------- ❑, Size:-Dia eter------- ---------- ---- ---------------Depth------------- " --------------------- -------------Liquid Capacity-.'-,------------------....gals. Privy: Distance from nearest wel!____ '_-_----------------------- ---------Distance from-nearest,buildin 9 - ❑_ .Distance�to-•nearesf�lot-line_-. -- ` r — �"'` ------^ ----•- ---------------------------------------- Remodeling ----- -- Remodeling and/or repairing (desc ibe)______ _ ______________- �� f�, ------ --- ------- ^- - - -- --- -- - - - _ -� -----------------I---------------------------- ---------------- ------------ r -----------, --- r _.--- -•-.:-'---------•._------•--------------------------------------•------•-- --------------- --------------------------------------------------------------- _ .-_ ---- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun#y_ - ordinances, State laws, and rules and regulations of the San Joaquin Local Health Districf.r } (Signed)..... � ------ .I � �� --------------------- ----------- ---------- (Owner and/or Contractor) By:--------- - "-V.UztP4---------------- -- - ----- --------------------------------------.(Ti# (Plot pian, showing sizellf IdP-locafion of system in relation to wells, buildings' etc., can be placed on raver side). ► FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------ DATE. --- - -- - ------------------------------- REVIEWED BY__-- -- DATE- em--------------------------- BUILDING PERMIT ISSUED-_:-�------------------------------------------------------------------------------------------------- DATE- - Alte�ons �ndl recommen4atio s:__.- ------ ----------------------------------------------------- -- ._YI f.---inn .._ ---------------------------------- ------------------ --------------- J ------------------- ------ I` = a --------------------------------- ------------- -------------- - ----------------------- ---------------------------------- --------------- ------- F1NAL INSPECTION BY:. ----- Date = -----•-----------------•----------------------------------------7 —r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockfon, California l Lodi, California Manteca, California Tracy, California I . ES-9 - 145x46 nrwano i