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J 5 APPLICATION FOR SANITATION PERMIT Permit No. _. . ./_ . I'll)1CNI (Complete in Duplicate) Date Issued --------- ------ -- San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the This application'is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---.__.__V34-2---- - .f " ----•'------------------ �r7? -._ Phoneme - i'1 --------- -- Owner's Name------------------------- ----------------- Address_-__-.-- ------------------------------------------------ ---------------------- ---------------- ----------- ': Irl ---------- ---- --- Phon Contractors Name_:---_---_-__ --• -- • `�Apartmen} House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Installation w111 serve: Residence - f� Number of living units: - ;.- Number of bedrooms Number of baths/---- Lot size ......./`--• -----'!> ----f --------- Water Supply: Public system71�ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3,feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe Hardpan [I tt Previous Application Made: Yes ❑ No F1 New Construction: Yes E] No FHA/VA: Yes E] No ,1 TYPE OF INSTALLATION AND,SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet_) is Ofance from nearest well-----------`--__Distance from foundation----------- --- Material-___:__.__.. ----------------------- m No. of com4rtments--------------------------Size------- Liquid depth----------- --- ----------Capacity li �-- sal Distance from nearest well_.t`t --Distance from ion to nearest lot line Len th of each line_ ____.__.Width of trench Number of lines g :- Type of filter material_ L- !� ---Depth of filter materiaL__.l ----Total length______ +Q.--------54-------------- Type --• r , See a e Pity Dis#once to nearest well from foundation__1-A-°---•__..Distance to nearest lot line-__.; ----__ W �( pp7 Size: Diameter-_ �� De th--.--- - ------------ ----------- ----------- _ - Number of pits- `-----------____Liming material- --- . -.---- --- p Cesspool: Distance from nearest well__.-.--_-._-:__-Distance from foundation------------------- Lining material-___._-.-.___ ------------------------ Cesspool: ---------gals. ❑ -----Liquid Capacity Size: Diameter------------------ ----------------Depth--------------------- --------------------- Distance from nearest building------------------------------------------ Privy: Distance from nearest Well.____.._----------------- - yy ❑ Distance to'nenrest lot line--.__. _ •---- ---- -- Remodeling and/or repairing (describe):._._ _-____ -----------------------.--------------------------------------•------------------- il I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, $t laws, nd rules and regulations of the San Joaquin Local Health District. L I' ..... ----------_[Qh e or Contractor) (Signed]------- ---------- --_.__{ .. A_1 Title Br-----------------------------------------------•----- ----- [ l - - ------------ ---- - --- - (Plot plan, showing size of lot, location of system in rel a .0 wells, buildin , etc., can be placed on reverse side). FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY f -- ---------------------- DATE-.-________ / -{- --------------- ------------- -- ---------------------- REVIEWED BY---------------------------------------------------- - --------------- DATE------------------------ ----------------------------------- BUILDINGPERMIT ISSUED---------- -----------------------------------------------------�y ------------------ Alterations 4nd/or remmEndations:_ :----------------------------------- ------- ---- -- ---- 27x- ----t - --------------- "� --� - -----•---- - -- ------------ — ------------------- ------e-------- --- -- -------- -----------57--------------------- --- - ------i -------------------�-- --- Date_...- ---- -------------------------------- --- F1NAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street ;. y Lodi, California Manteca, California Tracy, California Stockton, California �� ES•-9-2M Revised 1.57 EP,CO.