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l ��'� ��' • APPLICATION FOR -SANITATION PERMITe" NQ - �Com lete in D -- ` . P Duplicate) u .�` ` ��' _ - 'Date Issued ___ :-- _-- Application is hereby made to he"Son Joaquin Local Health District for a permit to construct_ and install the wo This application is made in compliance with County Ordinance•No. 549. erein describ d, JOB ADDRESS AND LOCATION. _._ .�_�6 �l h� �, �� flt�_4 q II _ .1__► �. e--------------_-------• Owner's Name-��"-�----�-��-1- � � c -•-- ----------------- --------------- 5---•-------------------- Address-------- 61 s - Phone. _ Contractor"- Name- _Q Y}: y. ----------------------------------------------------- ------------------------- --- ------ ------------- Phone--- Installation will serve: Residence Z Apartment House [3 Commercial Trailer Court ❑ Motel [:] Other ❑Commercial E f- Number of living units: Number of bedrooms -�• ' Water Supply: Public system Communit system Number of baths _-�.__ Lot size --- -�--x IOP E Pp Y� _ ----------------- Y Y ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ I: No R1 New Construction: Yes � . No ❑ _ TYPE OF°INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from. nearest welf__h%-Q O_�_DistanFe from foundation_--4 d !_ No. of compartnments . 9 i .Materia!_.- �� ( �y�y.� q, --------Size-- --x�-X� . - ---- -��- N Liquid depth Capacity ----0- Disposal Field; Distance from nearest w I ---• Distance from foundO�n---IdDistance to nearest lot line___ -- V Number ai lines---------------- ----- ----- ----Length of each line-- ---- _. - Width of trench------- Type of filter material_- oe ------ -----------Depth of filter material-- -----------Total length-------- i Seepage Pit: Distance to nearest well .-_ -----------Distance o ---_---Distance from foundation --__ -- ._ -.-.Distance to nearest lot line __-_ _- �� ❑ Number of pits-- --- --- --- --- ---Lining material__;--_-- _ -- W ------.Size. Diameter---------- ------------Depth------------------------ --------- 0 Distance: Dia from nearest well-______----------Distance from foundation--------------------Lining material--.- -.-_-_-------_ ❑ Size: Diameter-----�-------------- --•--- ------ Depth---`------------------------------------------- t -----Liquid Capacity-. Privy: Distance from -------------------------- nearest well----------------------_ gals. El Distance to nearest lot line-- _Distance from nearest building --------------------- -- g---- -�-------------------------- ---- ---- -------------- Remodeling and/or repairing (describe)--------------- I •-------•-- -------- ------------------------------------- ----------•---------------------•------------------------------------------------------------------------------------------ ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and `regulations f the San Joaquin Local Health District. . _ , 74— (Signed)..- 8 ----------- --------------------------- --- (OWne;and/or Cbntractor -_' a :. By:.- ---------�!�- -•- - - -��t.��^J------- �---------•---•---•---------- -------- ----(Title)-- ,�,� ) (Plot plan, showing size o of, location'of system in relation to wells, buildings, etc., can be placed on averse side). �1�1 } I FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED 6Y------ _- --- REVIEWED BY �- ---------------------- DATE---'/----� -�- ------------------------- --------------------------- ------- ---=--- - - - -------- -- ----- BUILDING PERMIT ISSUED -- ------- DATE-------- ------------ -- -------------------------- - ---- Alterations and/or recommendations:,".,--.,,--- ---_- - DATE------------------- ------------------- ------- - ---------- ---- - ---- ------ - ------------- FINAL` INSPECTION BY:- . ---- ------ Date--- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street 300 West Oak Street •{ Stockfon, California Ma ntecteca, Calam al Streeiforniat Lodi, California Ma814 North "C" Streef Tracy, California f E5-4--2M 10-52 Revisod W-2100 I+