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APPLICATION 1=0R SANITATION PERMIT Permit No. =q___c;r7-- Duplicate) I i (Complete m Dupl ) Date Issued .--- ��-----�. Application 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 Ne549.. JOB ADDRESSXLDL CATI N..-__ ---`/-------- -- - ---•---•--------------------------------I-------- Phone.-------:---------------------------Owner's Name-- - -------------------------------- - ------------------ 1 - Address----------------- - --•---•----- ---�--------- --•------___j---- •---------------------------------------------------------------- --- ----------------••--•----- ---•----•------• -- ------•-- •------------- Name------ ----- -- --------------------------------- -- -)-- ----•--------- --------------------------- Contractor'sPhone Installation will serve: Residence t�Apartment House-[] Commercial ❑ Trailer Court ❑ Motel'❑ Other R JI x t7 Q ----------------- Number of living units: ___!____ Number of bedrooms ---I--- Number o baths .__�"-_ Lot size ______ _____________ Public system ❑ Community system ❑ Private Number to Water Table ________ ft. Water Supply. Y Character of soil to a+depth of 3 feett Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [vj�New Construction: Yes f No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee .) s nn ---._.. Septic nk: Distance from nearest weli� istancp fro fo a*tion�_[!______________ a�ejial______"______-"__________-_" ��jj -Li Liquid t -- - '-- ------------Capacity--- No. of compartments------------ - -L_"..-"_Siz :" " -- q p• z Z _.' Distance to nearest I t lin �r (1' �1J Dispos Field: Distance from nearest wel ----- -. istance from foundation_ f."_.----- - f Length of each line--------- __ Width of trench"_-_ - r Number or lines_-�--_-__-- --1-- ---"--- - 9 ¢- Type of filter materi _aepth of filter material____ ____Q_ __-__._Total length_-__"_____ !1 Seepage Pit: Distance to nearest well______________________Distance from foundation-___________.______.Distance to nearest lot line----------------- N, � ❑ Number of pits"_J------------------Lining material-----------------------Size. Diameter----------------- ---..Depth I Cesspool: Distance from nearest well_______ ____"Distance from foundation"_ ____._______--.Lining materia-_"_____________--------------------- -----Depth--------- ------------------------------------------Liquid Capacity--- -----------------------gals. ❑ Size: Diameter--=�----------------------- - Q Privy: Distance from nearest well-------------------------------- Distance from nearest buil ing------ ------------------------------- Distance to nearest lot ine______--"________-__"._ ----------------------------------------------------------- El ----------- 31 F RemdeliQ an repairing [describe7:-------------------------------------------------------- jj ------_-----------•-•-------------------------------------------------------------------------------- ---- --- - ... ' - - -+ _ - - --- --------- -- -- -- -- - ----------- --- - ---- -------------------- I hereby ce iffy prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, Sf e end regulations of the San Joaquin Local Health District. // __-__-_{Owner and/or Contractor) , --- - - ---- -------------------------------------------------- ------------------- 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 APPLICATION ACCEPTED BY_ :__ --------"-- DATE _"-------------------------------------------------- - ----------------------------------------------------------------------------- REVIEWED BY__. . ---- -- --- .. -" DATE_ - BUILDING PERMIT ISSUED-------------------------------- -------------------------------- ------ DATE------ Alterations and/or recommendations:---------- ----------------------- ------------ -------------------------------------------------------------------•------------------------------- --------------•----------------------- ----- _-"------------------------•---------------------- -------------------t--------------------- ----•---------- --------------------------- -------------------- ----------- ------------------------------ I FINAL INSPECTION BY:-----------4---- ----------------- ------------------- Date_ ----- ---- - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Stree+ 814 North "C" Street 130 Sauth American S+ree# Trac , California S+oekfion, California Lodi, California Manteca, California Y ES-9-2M io-52 Revised W-2100