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�� � APPLICATION FOR SANITATION PERMIT Permit No. 3...� .. � S�v /�� (Complete in Duplicate) /� �It I SCANNEJ%fe Issued - �/53 application is hereby rude 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 Cr mance No. 549. JOB ADDRESSD LOCATION -"� �-Z ,r--_ / ' --- ---------- Owner's Name."'. -- - - -- -- ------------ --- -- -- - - -------- - - -------- ---- -- ------ - - - Address------ ------f-Z 1. - Phone. - - - _....o ontractor's Name---" ... ..... ---- - - ---- - -- - -- - - ---- '----- - - ------ - ---.- Phone--------------------(�-/6--------- -�-...." Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motelr ❑ Other [ Number of living units: -_�... umber of bedrooms ..t2A. Number of baths -./._ Lot size .---c5.W Water Su — "C7/ - --------- Character Public sysfierri - C'ammunify system ❑ -Private ❑ Depth to Water Table --...-"- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam C] Clay El Adobe[✓]Hardpan [j `_ Previous Application Made: Yes ❑ No New Construction: Yes [ No ❑ \ TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if publiF sewer is available within 200 feett) NX Septic )4n k: Distance from nearest weIICa((.�P"p t ' Q )7y�rt�• 21, Is a Se frorp foundation"......-".._---"_, ater- I _- -"-- No. of compartments._--_---_ -------- parfmonts -x X� f . Liquid dgpth:-- Ca acit 57�(1 " ' ) - - P y GJ - Dispos Field: Distance from nearest eIIJ, J'�'pistance from fondation".f U".f^_ istance to nearest I$t III -------- Type l lines_.._--". ..-------- . Length of each line- Width of french_--- -- y p ---------- Type of filter mate QQ'�---'"' // - ----------... r-- .. ..-__.Depth of filter material."..."I[]." -----.-Total length-..-----"-1"-�.Q---" -------"" Seepage Pit: Distanc to nearest well-----_.--------------Distance from foundation.-----__.-.----...Distance to nearest lot t - . - - line------ El Numbe of pits.------------------Lining material.-------------------Size: Diameter--------i_ ------ --- Depth---- ---- --------_ Cesspool: Dista from nearest welL.-..---._.-_Distance from foundation--- __._...-_Linng material .. --- . ❑ Size: is afar.-----------------_-----------_Depth------------ . _..._. .. _ ."-----_""__ ""_ Privy: Distanaom nearestwell_..._.._.".._--._-_"_ D _Li uid Ca aci�' '- ' -- — -----gals. El Distanceto nearest lot line _-"""_." Distance from nearest building. ---- ------------_-_- _ ---- ---------- --..__.--- Remodeling and/or repairing (describe):-------- -----------_------------ -------------- ----_"" " I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and!rules and regulations of the San Joaquin Local Health District. (Signed)rwing : -------1- - {1--�`-=(.-1,�i-:Lf' - ----- (Owner and/or Contractor) -- T+le(Plot piasize of Io+, location of sys+em in rel on to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY BUILDING PERMIT ISSUED -- ------- ------ -- ------- ---------------------------------- APPLICATION ACCEPTED DATE�------------------ - - ------------- ----------------------- - - REVIEWED BY.-.-._..-."_-". . --------- - - ' - --- -- -- - DATE ----------------------------------- - - ---------------------_-----"---T------------------'"- - ----------- ----------- DATE..----- Alterations and/or recommendations :--- ----- " --.- -- - - ---- --- FINAL INSPECTION BY:.-- bli ' 1,3 1JG/�3 -- Datef { SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Sfreef 300 Wesf Oak STreef 132 Sycamore SfreeT Sfockfon, California 914 North "C" SfreeT Lodi, Celifornie MenTaca, California Tracy, California ES-9-2M 10-52 Revised W-2100