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- r) APPLICATION FOR SANITATION ir"9MIT Permit No- -----..:._-_----.----. f.s Date Issued (Complete in Duplicate) Applica-ion is hereby made to the San Joaquin Local Health District for a permit to�e�n�struct�+and ins�`IIJ�h or %erre n described This application is evade in compliance with C_ ouniy ordinance No. 549. P i -x''" <> j� '= ��'' fA JOB ADDRESS ANr��ATION-r--.. . Y ? - -" y 5 lr' ` �,� .�s- �.. t=;A _.<-� ................... ...............��,- z ---' - -... Phone-'---------- -'--'-'---------" J�' i -. c.g � �. Owners Name.......... � . F' � -------------------------------- Address -----------------------•- �— r i �. - ---------------- ----------- Address------------------------------•-------------------- -=-1�-- .. l �,� _ _. z. hone/ Contractors Name...-_..._�_`-"-._�-..--"= --- -`-�`_="�""-"��ouseJ��Commercial ❑ Trailer Court ❑ Motel ❑' Oth'er �-'- �. Installation will serve: Residence partment � �- �i'... c.� =� ---- Number of living units: .......- Number of bedrooms -------- Number of baths ....--"- Lot size -..'_ Water Supply: Public system ❑ Community system ❑ Private `epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ 1. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �Hsrdpan L Previous Application Made: Yes ❑ No D,--�New Construction: Yes 0--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _,--(No septic tank or cesspool permitted if public sewer is available within 26� feet.) —i`I Distance from nearesr well... .......... ."Distance from foundation_-._-_Materia .capacity No. of compartments... ' S;7e--------------------------------Liquid deph----------- -- -'---- -------- - ---„' �� Distance to nearest lot line_/_:)_ Dal ' Distance from nearest well. "--_pistar,ce from foundation....:.....:......... dumber of lines--- Type _Length of each line.-_ k '°_-"--- Width of trencn.--.-.tT �----------------- ` ( yf �� Type of filter material _. `. De th of filter material-.-}� '- `- --..Tota! length.--.--- =-----"---------------- r U P Seepage Pit: Distance to nearest well ___..--------------Distance from foundation....----------------Distance to nearest lot line.............. ❑ Number of pits ----- --' ----"-- '--- -.Lining material------ --'- - ---'- Size: Diameter--- ----'- --------Dptn--------- - '--'--- Cesspool: Distance from nearest well.................Distance from foundation - _-"" Lining material-__.-.-------------------------- . ❑ Size: Diameter -- ---'- --------- ---------- -Depth- ---- ----- - --------- --- ------ _._--Liquid Capacity------- ----------- ------ge Privy: Distance from nearest well--------------"-.---------- "'"- .... -Distance from nearest building.------------------------------------- ElDistance .......... e to nearest kot line --'----' -- --- --- ---------- ----'-•------ ----------- - ----------------'--'-"--'---.. Remodeling and/or repairing (describe)---- ---'-- ..... ------------------'"-------------------------------- ----- ...... -- - --- ---------------------------------------- ------------- ------------------------------------- ---------------- -------------------------------- -----•---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cout ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY &NIGHT 1, / aero. and/or.-.Contraei (Signed). --------Sopti-c-Tank._%e4wir-0---- ------------- ---- ; �. $ .2o6 So.Eld arado HO 2-70.�.g - (Title) :r2��--------------------- --------- y'= ------------------5 ocktpi Y,-motif ------ ---------------- --i [Plat plan, shoring size of lot, locatwn of system m relation tg e1ls, buildings, of ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------' DA TE :- ... r }:_._ DATE. ---- ------' = = REVIEWEDBY-'---- - - ------------ -- ------ ----------- -----"- -'.-----"`----- : ' - ----------"- ------------ BUILDING PERMIT ISSUED---' -------'- --------------- ---' .............. ---'------'- .......... - - '- DATE------- --------- ---- --- --- '--'----' .............. Alteraiions and/or recommend at ions:........ _ ...... i ------------ ------------' Q ' -� ----- 4----' - : Date.......... F - `.... FINAL INSPECTION BY:..... ------ -- ----i- ------------- -------- - - ------ ---'----...- '- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street 132 Sycamore Street 614 North "C" Street 130 South American Street Trac California S+ock+on, California Lodi, California Manteca, California ri