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APPLICATION FOR SANITATION PERMIT Permit Na. _._�-_3�-�---•• (Complete in Duplicate) Date Issued _SfA3r Applicalion is hereby made to the San Joaquin Loca! Health District for a permit to construct and instal the work here described. This application is made in compliance'rwit,h County,Ordinan4 e No. 549. f JAI JOB ADDRESS A l>,OCATIONa ;� �-'` -- j ! .1 Phone---------------------------•-------- Owner's --------"----C--- _-._� ..t_ Address. ...........+ ----------------- -------------------------------------------------------------------------------------------- ...---•-• . Contractor's Name. Phone----------------------------------- - - - --------------- Installation will serve: Residence [V Apartment House ❑ Commercial ❑ Trailer Court ❑ Moofell''❑ Other 0 Number of bedrooms _Z__ Number -baths --!___ Lot size _f + -'!�►�- -- '= -7 I Number of living units: .` � Water Supply: Publics stem ❑ Community system ❑ Private [Depth Water Table -_---_ ft. WatY Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loa/ Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes No TYPE-OF INSTALLATION AND SPECIFICATIONS: ~ (No septic tank or cesspool permitted if public s6we is available within 200 feeth _,. fro -- - L _ �.�Septic Tank: Distance from nearestwel _ ��---Distance { � . � - Liquid ------ - Capacity__ No. of compartments----- _Size_ - ' ( ' Distance to nearest lot line _ ----- Dispos I Field: Distance from nearest �wel --- -I-"--instance from foundation_ f ' Number of lines---------ic.,' -_-- --_-- ength of each line-----.----, 7 .--- Width of trench---.------ - -------- ,fr�H*+ .Total length---------------- -------- Type of filter matendl th of filter material.. .--__---- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line------------------ ❑ Number of pits- ------------------Lining material---------- ------------Size: Diameter-__-------------------Depth------ ----------------------- --i i Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material---------------------------- _----...- ❑ ---------.De th------------------------------ --Liquid Capacity----------------------------gels. Size: Diameter----- ----- ---- ----- p ---------- -- 9----- - ----------------------- ------ � Distance from nearest well-------------_.-_--.________.._--.-_-.----------Distance from nearest building li �., Privy: Distance to nearest lot line--------- -------------------------- ---------------------- ----- ------------------------ 1. Remodeling and/or repairing {describe} --------------------------------- - - 'I --------------------------•----•-----------------------------------------•---•------------------------•----------•------------...---------•---•------------------------------ I ---------------------------------- ------------- -------- ------------------------------------ -----•----------•---------------------------------•----------------------------------------------------------------------i 'J I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County9+; ryj ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. R IBJ 3 -�_.. v !14-1 ------ -. ------------------------------ Owner and/or Contractor �I (Signed)---- = r - ----� I -------------------------------------------------------------- BY=-----------•----------•------- -- - -- - (Title) ----------------------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, a#c., can be placed on reverse side). � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_-------- - -- DATE_--------------------- ---- - -- - -------- ----- --�-------------------------------- ----- REVIEWEDBY-------------------------- - -.- - - ----------------------- ------------------- --- --------------------------- DATE-,,�---------------------------------------------------- BUILDING PERMIT ISSUED--------- "': --- -------------------------- • DATE--- Q -------- -----------------------------------•----- m Alterations and/or recommendations:____---_ . ----------------------------------------------------- ' --------------- ---------------• ------------:-----•------- - -- _ --------------------- -- ------ --- ' L J t ------------ --------- ------ -- -------- -------------------- -- —` f ' � �m�---- ------ f � . Date-- --------------------------------- ------ --------------------------------•-�- FINAL INSPECTION BY---------------------- ----1------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South American 5trae+ 300 West Oak Street y Trac California '"- Lodi, California Manteca, California Y. Stockton, California E9-9-2M 145446 ATWU0D 12.54