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\4 - APPLICATION FOR SANITATION PERMIT rmit No. ... d--�..�.... (Complete in Duplicate) µ w Date Issued,,.__.... 2_. » , Applica+ion 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 No. 549. r - 1 JOB ADDRESS AND LOCATION..P!J--- ------..C,c •---- /,%. `L. .O ----•- ------------------------------- Owner's Name-----X'-----------J9E ----Z=------•-------------------------------------------------------I---- ---------- ------ .... Phone-----------•--------•--------------- Address-------:.1?--T-----1f ,.X �'- fr r ''� � -- Contractor's Name-----=-- nRl��s �-��' - •... ".... Phone -= Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court+ ❑ -Motel ❑ Other "t+-i F _ Number of living units: .__."__" Number of bedrooms ------- Number of baths ___:__-_'Lof.si2e ---------.__""_-------_.........___________________________ Water Supply: Public system ❑ Community syste"m ❑—Frigate RI-Depth to Wafter Table ----- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Gg--,Hardpan Previous Application Made: Yes ❑ No [ New Construction: Yes �o ❑ -+T1 TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' - x Septic Tank: Distance from nearest well___ .D------ Distance'_from fo_undation__.__�_:v__:___ Material_-.- _-�.---13�',_C a[_.-__._. No. of compartments------ -�-.__Size----`�• -��f_-s_L_ Liquid depth-----6-I-J-'---.----._Capacity_Z�_Q-0------- r Disposal Field: D+stance from nearest welL..�z..Q.._.-Distance from•foundation:_-'__�- .Q.f.__.Distance to nearest lot line.___ ------ Number of lines___________......_.._" . /r_"_Length of each'line___-____3--d-- ........-.Width of trench---------- ------------- Type of filter material-------1 _30Depth of filter material_.....1_6.._�___..Total length---------- _ _-- ------------------- Seepage Pit; Distance to nearest.well-_/K__Q-_-_.____Distance from foundation__.._;%_.__..Distance to nearest lot line----------------- Number of pits------ ----------- material._ __ _.t,4+____.Size: Diameter__..-8- ......Depth........... ________ Cesspool: Distance from nearest well--------.- -_Distance from foundation_';_`".i_°___.:_..Lining material-------------------------------------- ------------- ____________________________ _____. Size: Diameter_-------.--"--------------------------De th____-"------- - "-- �'� ' ' _Li uid Ca acit ❑ -- P -------------- - q P y�--- -------gals. Privy: Distance from nearest well-____________________________.____.-_---- --._Distance from nearest building------------------------------------------ Distance -.--.-____.__-___________ : ._._ ❑ Distance to nearest lot line-Y" - ------..,.._.------.4 ----- ------------------------------------- z Remodeling n /or repairing {describe):------ 5-1 /'��f----------- ......:...::::�F�l'.Il ----- / G-t .0=-�P 9---• -- r, -----------•---..--------------------------------- -------------------------.------•-------=-------------•; ----------- -----------------------------------------------------•----------------------------------------------- ;.:-------------------------••-•--------------•-•------------------- -- ---- ' ! hereby certify'that I have prepared this application and that the work will be done ,in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the-.San Joaquin Local Health District.T` 1- S ¢. (Signed] �` ' ---------- ------ caner and/or Contractor) BY� / sem f ::.(Title} -ter 1. (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 A APPLICATION ACCEPTED BY---- --------_-- - - - -----------r--------------------------------------- DATE---- j REVIEWEDBY-------_---------- ----_-------------•------- --- -------------------------------------------------- DATE ��----------------- ------- BUILDING PERMIT ISSUED-------•------- ------ ---- --------------------------:-------------------------------- DATE..". ---- - ----------------------- --------- Alterations and/or recommendations:--------=--------- ------------ ------------- -------- ------ -------•------------- - ._. --------- ---- ---------------------- - -----• 4 -----------0 "NSPECTION BY:.. c!�� `� ......................... Date:_..._ _(-"--"' - ------.5.-c...... ------ i SAN JOAQUIN LOCAL HEALTH DISTRICT sricbn Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street (111ifornia Lodi, California r Manteca, California Tracy, California S srN 49e arwoop _