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APPLICATION FOR SANITATION PERMIT Permit No. _ - ...------ (Complete in Duplicate) T Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descyii This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------------------------------'----- - is-_tract_� prix>~ r:-bane. Lodi--- a '---- East 88 ft. lot I2 Da_ Owner's blame �___bQrt...D3 - --•------------------------------------------------------- Phone g3ii� ' route 3•$ox 264, Dodi Cal. Address---------------- r --------------- Phone----------------------------------- Contractor's Name----------- ---------- -- ------------------------------------•-------------------------------------------------------- l Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _. __.. Number of bedrooms3..-.... Number of baths --_.._ Lot size __ a__ --- --------------------------------- 1� Water Supply: Public system [I Community system ElPrivate L} Depth to Water Table _.YB. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [I Previous Application Made: Yes ❑ No f] New Construction: Yes [j No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �- _: • 52 �. - �� Ion- r Septic Tank: Distance from nearest well...-2,--- Distance.-from foundation.................�.Ma�...... _.------ e_.. No. of compartments-------------- -----------Size-------3��,------ Liquid depth Capacity-_810-0. 4 w n. 25 Disposal Field: Distance from nearest well._..... ._.-._Distance from foundation-.-.__ ...._.Distance to nearest lot line....-..-..-I ❑ Number of lines---- -------- ------------------Length of each line_7_0_,_I4,-24,Z nth of trench.------,or i---------------F Type of filter material--I-_/2---r.00k.Depth of filter material_.-.18-r. ...........Total length......;LBO----------------------------- Seepage .._................. Seepage Pit: Distance to nearest well_____ w:. ---------Distance from foundation....................Distance to nearest lot line-----------❑ ast bereof pits----------------------Lining material---------------------.Size: Diameter---------------------- Depth-------------- ------------1Cesspool: from nearest well-.-_-_.... `__Distance from foundation _Lining material----_ _.----__- -Size: Q:iameter •_ " ---_-----•-----------D.eplh_---_-,� ---------- ----------Liquid-Capacify------ _..Distance from nearest building 1 Privy• Distance from nearest well-------------------------------- ----- ' ❑ Distance to nearest-lot line------------------------------------------------ ---------------;----------- ---------------------- s ♦. ` Remodeling and/or repairing (describe)---------- ---------------------------- •-------•-•- --------------------------------------------- -----------------------•----` i - -----------•---------- ; ---------- `"------------ -----•-------------------•------------ ----------------------- --------- -------------- ---------------------------•--------------------------------------------------•-••------------------------------------------------------------------------- -------------- I ------- -- I hereby cerci.y that-have prepared this application and that the work will be done in accordance with San Joaquin County ` 'r 6tdinances; State and rules and regulations of the Soman Joaquin Local.Health District. 1 � ------ ----------- (Owner and/or Contractor � -------------------------------------------------------- (Signed)------------------- ;f �. --------- By: _�+ {Title)-------- tly=----------------------------- . -- -------------- ----- -- ----------------- ------------------------- ---- ------- :,_, _.,.(Plot_plan.,tshowing size of:lot, location of system in-relation to wells, buildings, etc..-can-be-p16cezi-6ri`reverse side):` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-- ------ -------------- ----------------- DAT ----------------------------------------- --------------------- --- Y - D' _BUILD NG PERMIT ISSUED.. --------- --------- DATE ----------------------- Alterations and/or recommendations--------------- ------ ---•---- -------------- - „ ✓ r .....---------------------------------------------------------------. T _ .................._......-.------_-__.-.---.-._..^.--._..- ---- -.-.__ ---------------------- FINAL INSPECTION B :. ----- Date--,--. ; SAN JOAQUIN LOCAL HEALTH DISTRICT A 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street /r I*a Manteca, California Stockton, California Lodi, CalifornTracy, California ES-9-2M 10-52 Revised W-2100 '