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r �\ APPLICATION FOR SANITATION PERMIT Permit No. !y \ (Complete in Duplicate) SJ' y j Date Issued -- -- -- - ------- A YiCation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. PP Y This application is made in compliance with County Ordinance No. 549. /1 --emu--- f�- `� .. _ - ,`_ ............_-.--------•- -_ , ` t��•.'1_:------ --- fix--��. .� ----------------------------------- ------ Owner s Name._.. %j-f -' -------�r--------- -- ----- ----------------------------- -------- Phone-- -`'�� `�� --------- Address..... .......--------------------------� �/J-_-_;z-f-C t 4�`_:`# .f ._A,.._,. ,•-------------- ------ -------------------------- ------- -•- � Contractor's Name--------------------------- -------- - •� c ------------ ------------- al--------- - ----�-� --- Phone.--�---,-Jif--1 � Installation will serve: Residence ❑ Apartment House ❑yCommercial Trailer, [-] Motel E] Other ❑ Number of living units: �_ Number of bedrooms . -_ Number of baths_ Lot sae .-__ --- _� �_ Q_-_______.______ Wafer Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 4447 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (' Hardpan ❑ Previous Application Made: Yes [] No EK New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i 1 (No septic tank or cesspool permitted if public sewer is available within-200 feet.), . . .. ..,...�, _ ....,. , .. .�,.._ Septic Tank: Distance from nearest well- -O t�_Distance from foundation_�_�__.________.Material___ - ''_ S_____________ K No of carnpartments--- _______________Size �t ____ _- _��._ Liquid depth _r- _Capacity_/-0476 70" f r Disposal Field: Distance from nearest well-tA_,0 m e__Distance from foundation---/.S�________._.Distance to nearest lot line____._____ -P ---------------Width of french-- ��'------- --------•- Number of lines___.__l__,___7.-��_--___.______Length,of.eaeh line____ _ N Type of filter matenal_1�7j_-_l�-------Depth of filter material___ _ ___________ Total length----8.0-_ -__-._._______,___..__._ ` _� -�... - �... - Seepage Pit: Distance to nearest well.... _l~k_&__._Distance from foundation___1_a________rt_.D's'tance to nearest lot line_-_�_�_-.._ Number of pits------- _.:_^ --Lining material_te,5, f 'Size:,Diameter_--__._ ------Depth-_21-5--1 epth_:21_,J_ _________________ Cesspool: Distance from nearest°well_________________Disfance.from foundation-----.------------- Linin material----- ------------------------------- El Size: Diameter-----------"-------- �-----------'De`th----------------------- I ----------I=i uici'"Ca acit -------gals. Privy: Distance from nearest well ------- ---------------------_-------------Distance from nearest building--------------------------------------- ElDistance to nearest lotTina--- - ------------------------ ----------�------------- ---------------------------- A-c-_1Remodeling and/or repairing (describe):------ C - - f _.__? �..:_:. ` - - - --"„�. ---:------- t _ --err - - r ----------------•---------•-------------------------- ------------------------------=---== -�°•---------------------------------------------------------- -------•-------- =----------------------------- ` ---- I I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State iaws,`an rules and reg lations of the San Joaquin Local Health District. .(Signed)------------------------ •�C4A&!- 4 ----- �` 'L' ------ ---------f--------- - -------------"� �{ n rrd or Contractor) Plot Ian, showing size of lot, location of system in rel n to-w -- - ---- ------ ----(Title)-- r7 l�a�-- '✓------------------------ ( p g y ells, buildings etc., can be placed on reverse side). t FO DEPARTME T USE O LY ' APPLICATION ACCEPTED'BY___4 ---•�;"`- - , .�Z .. - - - :------ DATE----- -- ---- ---- REVIEWED BY - ------------------ DATE ... ------------------------------- BUILDINGPERMIT ISSUED-----1------------ ----------------------- -- ------ DATE----:---------------------- ---------------------....------ Alterations and/or recommendation . � 4r 'L " +� lir% --•----- f 'are+r� ` ------- / _ _! 1� ,, ------------ - 67 - --------- - --- ---------- ' ------------------------------------- --------------------------------------•---------------------------------- i i - FINAL INSPECTION BY:-------- =-----------_- Date-- ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street. f $14 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California , ES---9-2M io-52 Revised W-2100