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\� 1�� �\� APPLICATION FOR SANITATION PERMIT Permit No. ..... l--__ - (Complete in Duplicate) Y 7 ,u„� �,�,,,�' „� • Date Issued .._�___ `_y • Applies+ion;is hereby made to the San�Joacluin 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. } J JOB ADDRESS: A LOC TIO ..... Owner's YName° - ------td--------------------------------- Phone---------.......... ----------- 'S r r �, ot Address----- 4 = - -'--- �^ -•-- -----•------------------------- --------• --------•-----..----- ••-•-----------•------ Conf�acfor's :Name-------------- ---------•---------------------------------•-- --------------------------------------------------- Phone---•---•------••------........._... Installation will serve: = Residence Apartment Hausa LlCommercial L] Trailer Court L] Motel E] Other E] Number of living units: __ ____ Number of bedrooms _ '_ Num� Depfh er f baths _-_I_._ Lot size _____F_s ._- � _ ________________________ Water Supply:' Public system ❑ Community system Private tWater Table -- ----- ft. Cha rac+er.of soil to a depth of 3 feet: Sand ' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ETN' ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if publi sewer is available within 200 feet.) Septic ank: Distance from'nearest welly.-;. D;stance fro 'foution_ID____...____.Materi I_ _____________ No. of compartments--- .__ SizeO..X-� _Liquid depth_--__--------%- ------Capacity----¢-- - � ��,,� " ' ' 9 Dispos Field: - Distance from nearest well. Distance from foundatio �_ __7_--------pistance to nearest lot lin ----------------- Number --------Number of lines__________ ________ Lengthof each Width of trench____-_--__ u _�____._.._ r, r - 7-1 Type 'or filter mater _._:_Depth of filter materiai---.._____�- ------ otal length_--.-.-_-__-.�_. _,-�--------------- 47 ' _ '"Seep Seepage Pit:. Distance to nearest well+__-__ Distance f :,.� rom foundation....................Distance to nearest lot line----- 0 ❑ Number of pits------=---------------Lining material----------------t------Size: Diameter------------------.....Dept h------------_-----------------._- W Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-_--__---- ------ --------- ❑ Size: Diameter- . .. - -- --- ----- Depth-------------- -------- ----Liquid Capacity gels. f� Privy: Distance from nearest well-=---------------------___---------___---.----Distance from nearest building----._______.____--__---_---.-_-_--_-_-. ❑. Distance to nearest lot line----------------------------•---------------------------------------------------------------------------------- ------'------------------- r� s r Remodeling and/or repairing (describe):.__-_-__'---------------- --------- ----•-----•--------------------------------------------------=----------------------'------- ---------------------------------------------•--------- f ----------- ------ -------=•------ '--r------------------------------------------------------------------------------------------------- -------------- -------•---- -•--•--------•-------------------•------------------------------------------- - -- I�hereby certify that I have prepared this application andAaf the work will be done in accordance wifh San Joaquin County ordinances, Sfafe laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------•---- _..... �--- _-___� -- ----------------------------------------------------------- Ower and/or Contractor) BY:............................................................................. .----------------------------------------------------(Title)-------•----------- --------------------------------------------- (Plot -::---- ---------------------------------- (Plot plan, showing size of lot, location of system in rel fin to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------- DATEr- REVIEWED BY-------------------------------- -- --- ---------------------------------------------------- ----- DATE--- � -----------••- BUILDING PERMIT ISSUED----------------------------------------------------- -------- -------------- ------------------- DATE------ - -- Alterations pand/or<recommendations: -:.._:_tt.).. ......� ..............:••----- /• .1 1 fa-_ "' if•!-- ---- Imo-raC J - ----------- ------------ .-.s....__._.--r-_---............................c... = r 3. _? �'` . C, .,, `'�'.` ' J_ ��-E - ------- '-.... -------------------- - - t - --- 3 . . , ----- 194 -- -.---`2a e :BY . ...... Date_...FINAL INSPECTION : . ..... SAN � _JOAQUIN LOCAL HEALTH DISTRICT ~` , - 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sid Stockton, California Lodi, California Manteca, California Tracy, Califoro, s..y EE-9-2M 145446 nTw000 17-54 - f5