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4- � APPLICATION FOR SANITATION PERMIT \�rrnit No. ... ..._ (Complete in Duplicate) Date Issued _.-------7--�•- 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. 544.` t C��./ S.icl j/4'F_�: d'tl. e .�.• x ----------- � JOB ADDRESS AND LOCATION_...-------••:----- F Q F ------------ _ Phone-------------------------------------- ----------------- Owner's Name----! --•------------------- -- " - _ . Address------ ......... X------9. __�F-------- R ' Phone--------------------------------- tot' C� Contractor's Name...----- ---•--- - -�-'-5.--•----�'--N- -'--------'=------- I�- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other* Number of living units: _"____-. Number of bedrooms ..------ Number of baths ---__:-_'Lot size -<.------------------------------ -- Water Supply: Public system 11 Community system ❑ Private R�r- Depth .to Water Table ft. Gravel Sand Loam ❑ Clay Loarn ❑ Clay ❑ Adobe 0—Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ y , Cg—No ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes i 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` c3 _--__Distance from foundation.". Se tic Tank: Distance from nearest well..,_.... ,e F, ..• /� C v tR.� d....Size--- ----'-. Liquid depth. a ac3 No. of compartments._..._"-.-- 1. Ii r Disposal Field: Distance from nearest weiL.-�_U_..--Distance fromfoundation_.�_ ��C"f----Distance to nearest lot ine................ Number of lines---.-- .1------- �y- Length of each line.-----.-3--CJ--f-'-�€ -.Width of french-------.---P V-- ------ Type of filter material-------Z&_30Depth of filter.material__ :-1.&_-----..Total length---------- -C-------------• •�-': ��'-".Distance to nearest lot line...`��".._--- Seepage Pit: Distance to nearest we4l._ --------- from foundation__... �. Depth-------_.c _s3----.-----_-- f ' .__.Size: Diameter_..."8 ' [� Number of its....... .- . . Lining maternal _ Cesspool: Distance from nearest well............. Distance #rom foundation- Lining materia-------------------- --gals. -- De Depth R -.L'squid Capacify"�---------------------• 9 l ❑ Size: Diameter-------------------- ---' ' p Distance from nearest veell.-....._.._.___". ----------- Distance - ' Distance from nearest builcling.----------------------------------------- Privy: ,.- sem...►-^-� ❑ ---------------- ----------------- -- --- Distance to nearest lot`fine_""_".__._.---1------ ..• - ' I I ' k • � � -D. : " ------- ------------- • Remodeling. n /or repairing (clescribe):..-_-.15�s' 1 .._:.'.-----------•------ r>i _. ---- --------------------------- ---- 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., � p� � � � ran r Contractor) .R)' 5. -,CI .'-- -- ------------=------ --------------- -------- w -- -- ne d/o tr or) t (Signed]_..---_ , (Title)_ ----------------------------------------- on to wells, buildings, etc., tan 4 hc:�f� --=--- ---. By:------ an be placed on reverse side). (Plof plan, showing size of ot, ocation of system in relati FOR DEPARTMENT USE ONLY DATE-=-------� =-------- --------------------------------------- APPLICATION ------=----------------------------APPLICATION ACCEPTED BY-------'-'- --'-'- -'-'-- - DATE---' ----��-------'----'----------------=---------- BY -- ------- ---- ------ ---------------------------- REVIEWED ' '= DATE ' ' -------\ ---- . BUILDING PERMIT ISSUED - -------`- 1 Alterations and/or recommendations:----------------------- - .. ' -----' ---------' -----------•------ h .--- -- da -------------- �J------------------------ ------------ . NSPECTION 'BY:.. w `"1,S~= '... Date... -- SAN JOAQUIN LOCAL HEALTH DISTRICT {32 Sycamore Street 814 North •'C" Street ariean Street 300 West Oak Street y Tracy, California ,f �'�eliFornia Lodi, California Manteca, California - Fe4S446 A7W110D