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h APPLICATION FOR -�' SANITATION PERMIT Pe mit No. _�,/.-�_"�-•' (Complete in Duplicate) } Date Issued Application is hereby made to the San Joaquin Local Health This application is made in compliance with 5oygtyOrdinance DiNoc549r a permit to construct and install the work herein described. t j ��LL JOB ADDRESS AND LOC ATION_.:___-_____- ----------------------------------------- -- SO_0_-T#t - - "� L_ L-- -- �` Owner's Name.........�•-----� `' .r.,.. - --- ------•-------•-•- •----- -----=---------------• 1_C K_�_i`-Lz-------- -------------- .- Address -- Phone -- ------ f,--- -------------------------------------------------- ---------------•------•--•---- - Contractor's Name ------------------••----- -• - ------ ___________________ Installation will serve: I Residence Apartment House ❑ Commercial Phone______________________ ❑ Trailer•.Court 0 Motel ❑ Other ❑ � Number of living units: __.,f__- Number of bedrooms ----- Number of baths -4__-- Of size ---------`-�-O-x__•_Z"�d Water Supply: Public _ �- -------------- .system - ❑ Community system O''Private ❑—DepW'to Water Table#"- ": Character of soil to a depth of 3 fee+� Sand ❑� Grave! ❑ Sandy-Loam ❑ Clay Loam ❑ Clay4 Adobe Hardpan Previous Application Made: Yes No ❑ 4 ❑ " 9 New Construction.`: Yes X. No TYPE OF INSTALLATION AND SPECIFICATIONS: ti .,.F (No septic tants or cesspool permitted if public sewer is available within 200 feet.) ! µ. Septic Tank: Distance from nea�es# well-_ _-"----" I / + D,s#ante from foundation ______1 ---------Material.. tJo. of compartments � Size x�� i ( 41K ,S-*�x----°� Liquid depth- --'L-�=------Capacity------- - r._ Dist Field: Distance from nearest well .6Z W --__ ._.-_.Distance from foundation------/d__------Distance to nearest lot line___-___J�__"/_" Number of lines--- -"-"Z'-_-_ _--_ r� v n Length of each lin'e__f:__--�Q___'d / �11/idth of trench.-----------�. '.._____" " Type of filter material- 4iAr De th of filter mater `� 5 al �� a Total length /--2-o-- Seepage Pit: Distance to nearest well----------------------Distance from foundation.........)-I" istance to nearest lot line----- Q ❑ Number of pits----------------------Lining material------------ Size: Diam�� er---------- -- ----- --Depth Cesspool: Distance from newest well-----------------Distance from foundation..___,+ __ --`.Linin ' • g material________________ ❑ Size: Diameter --------------------- ------Depth------------------1-- , -- ----- -- Li uid}'Ca acit gals.- ....... . I 9 j p 1Y- ----------------- Privy= Distance from nearest yell1--Dis nce{from+ nearest bu'ildin ❑ Distance to nearest lot line r g`------- ---------------------- ----- 4 .." i ------- - - ---------- --------- r Remodeling and/or repairing (describe):-------------_ s ______________________________ k y ________________________________________________ _ _ I hereby certify that I have re ared this application and that the i I Y y ------------------------------------- ------------- =--------- - done in ordinances, State laws, and rules and regulations of the San Joaquin L cel HealltheDis+r ct accordance with San Joaquin Coun+y (Signed_-- __ Al- ----------------------------------------------(Owner and/or Contractor) --------------------------- Plot plan, showing size of lot, location i t B y - -- -- -- ------- - - -- ------ --•-------g-, -- Title o s stem in relation to wells, buildin s etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY { REVIEWED BY DATE.------ -------------------------------- BUILDING PERMIT ISSUED------------ •----- D ---------- -#------------`----:- � -A DATE - Al+orations and/gr recom endatjpnsL; �w -._ �""^~ = - " ---------- Alterations --- S - !------------! SIE` tl = :r r ` : ----- --------- r . , . _. ........... CZ FINA. INSPECTION BY:_ - -------- Date--- '4 ------------ ------- -- -------- ISAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street w 300 West Oak Street Stock+ort, California 132 Sycamore $tree+ 814 North "C" Street Lodi, California Manteca, California ;�. Tracy, California �y-9-2M IO-52 Revised W-2100