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� �� APPLICATION FOR SANITATION PERMIT Permit No_ ___ ____ _ _-------- (Complete in Duplicate) -7 �� Date Issued - --- ---— -- ---✓ 3. Ap lication is hereby made to theSan Joaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance with County Ordinance No. 549. 44. JOB ADDRESS AND L CATIO __ r s 1 -------------------------------------------------- Owner's ---------- --------------------Owner's Name ' `-A +f_ -- Phone)---- �w''1 Address----r-- ILI . i Contractor's Name-------------- - Zwr � -------------------- - Phone I Installation,will,serve:,,Residence Apartment.House, »--Commercial.Elz railer Court] Motel ®•-Other ❑ Number of livingunits.} ____ Number of bedrooms A`^• a _ � � #� .� Number of batt s . Lot size ____,. -------- Water l _- } Water Supply: Public system; •�Cammunit . system r _ c y ❑ Private ❑ Depth to,Wat,br sTable. dit. Character.of-soil 4 a depth of 3 feet: Sande? Gravel Sand Loam " " ' .�- 1� ❑ f❑clay Loam(] Clay ❑ AZI Hardpan ❑ �. '�P.r��ev ous *pplication Made: des ❑ No� New Construction 'fY s vNo ❑ � \\ TYPE OF-INSTALLATION-AND-SPECIFI.CATIONS: (No septic tank or cesspool permi4ed if public sewer-is available within•200 feet.) - - ri Septic Tank: Distance from nearest well. - S s Vr _ �r`Dista from �oundat foundation �__--4___ No, of compartments_-.:.----- _._.__Size__._ �/ -l �, � 11 r4 --�1--�.=��-Liquid depth---�---�'"�----.Capacity----- • �._ 9 e Disposal Field: Distance from nearest well'________________Distance from.foundation-______-__.___-.Djstance.to nearest lot line__:____..-______. ❑ Number of line s---------__----I----------l -------Length of each line----:------V----- - ---.Width of trenchx_1._--____------------------ f Type of filter material___-. - ---------F-------Depth of filter material_ - Y.-.____----Total length-- ------------------------------------\n Seepage Pit: Di3ta`nce to nearest �Il Linin Distance f m fou a ' ______.D�sta ce to nearest lot Ime__._;j__.._ Number of pits.!... 111-Lining material .Size: Diameter------ ---------- --Da th___-- -® - ---------- Cesspool: Distance from nearest well-----------------Distance from foundation______--------------Lining material_--__._---__-.____________.__------- I t Size: Diameter- --------- ---- ------- -- -------Depth------------------------------- ------Liquid Ca acity--------------------❑ ---------- - ,,.,..,,,,...I' - ----gals. Privy Distance from neares well'_____ _____- Distance from nearest buildi �3. +i 9 -------------------- I Is a'nce to nea:es of f i,e------ ---------------------------------'- - i I I -- ------------------------- ------ --------------- I Remodeling and/or repairing (descibe):- __ __9------ --------------------------------------- -------------------------------- ---------------------------------------------------------------- -- - f = `= -- - i -- ----------------------------------------------�----- I I I � - --- --------------------------------------- ------------ I, - a- ---------------------------•-:--------------------------•s------•----------•; prepare ---------••-------------------------- hereby certify that I havedd this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and r fes nd regulatif the San Joaquin Local Health District. (Signed) - ------ ----- eced (Owner and/or Contractor) t By:----------•-------- ------- -/--------- 1----------- ----------------------•-------------------------------(Title) . f (Plot plan, showing [ze of Iot, location ofisystem�in}relation to wells, buildings, etc., can bereverse ide). l r , ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B;(? ----------------------------------- -----------------•-------------- DATE_r_0 __ i REVIEWED BY �� ------------------- ------------------ DATE----- --------------------------- BUILDING PERMIT ISSUED -1 I - --'- ----- DATE-- ,:� .: r Alterations and/or recommendations------- -------------- ---------------------------------•-- -t------------ -- i 11 --------------------------------- ------------- ------------------------------------- • ---`—-----•----. ------------- - --------------------------------------------- -------------•-I-------- =---------- -----------•----••----------------------------- ------------------------------- F FINAL INSPECTION BY------------------ -- -- - -- -- -'- --- - •------•-•------- Date_--------- f- ------------ r ` SAN'JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+ree+ Stook+on, Celifornie 41 Lodi.California Manteca, California Tracy, California f ~ f � ES-4-2M I0-52 Revised W-2100 ,�