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Lo APPLICATION FOR SANITATION PERMIT Permit No. 2/0 1"" (Complete in Duplicate) /-/SZ Date Issued -----/-SZ---- €:. Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install th This application is made in compliance with County Ordinance No. 549. e wort; herein described. ► JOB-ADDRESS AND LOCATION...... jLL�!LI C Owner's Name -" "'- / Address ------------ --- ------ Phone Contractor's Name. Installation will serve: Residence - - -- --- ------•------------- Phone------------------------•- Apartment House [J Commercial Number of living units: ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 _._ Number of bedrooms _ ". Number of baths ---/_ Lot size Water Supply: Public system -❑ Communit system Y,. Y ❑ Private [] Depth to Water Table " Character of soil to a depth of ifeet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam 'ft Previous Application Made: Yes ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Yes ❑ No [�� I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-_----------------Distance from foundation.___.- ` p No. of compartments---=- ---------------------Size ----------- ..Material------------------------------------------- r = Liquid depth---------- Dis osal Field: Capacity--------------- ------ a rest-weif_. Lpistance from foundation__-��"�_"..--Distance to nearest lot line___ isfance from nearest r Number of lines__ -__-_- en th -------- g of each fine f Type or filter material /r - ' � _-------.Width of trench---- °i �tr�'-- -Depfih of filter material------. ----Total length----._. --------- Seepage Pit: Distance to nearest well_2_zr_e_ _Distance from foundation_____ � r Number of pits------ ------------'Lining mafierial" � �/� Do tanc�efto nearest lot line__-"�"_" Cesspool: '',t.C4ize: Diameter__-" "_." __Depth p Distance from nearest well__.________- T � ---------------- -_-_-Distance from foundation--------------------Lining material------------- ❑ Size: Diameter--------------------- � ...� --------------Depth----------------- -- -- - ------------------------- Privy: � ---- - -- ---•-Liquid Capacity -- ------------- Disfance from nearest well------------------" --------------------------gals. Distance from nearest buildin ❑ Distance to nearest lot line--------------- =--- ---- g.='-----------__---- Remodeling and/or repairing -----------=--------- describe '________". - le& - ------ i z lr� --------------•------------------------------------ `- - - ---------••-----•------------------------•------- ------------------------------•--------------------•------------ --------------------•---------•---------•----------------------------------------I- - ------------------------------------------- --------- I here6y certify fhat I have prepared this application and that the work will be done in aordance with San Joaquin County ordinances,.Sfate.caws, and rules and ',regulations of the San Joaquin Local Health District. cc (Signed)-.- By: -- F Contractor) (Title} `' (Plot pian, showing size of lot, Loc n of system in relation to wells; buildings, etc., can be placed o arse s A -- -------------- ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY --__--- .._____�" -- -- - ---- - ---- IEWED BY ------- DATE - BUILDING PERMIT ISSUED - ------ ---------- ------- - DATE---•- -------\--- _ --- ---------------- Alterations and/or recommendations------F---------""_-- - - -- ---------------- DATE----------- ------------------------------�-._ .. •-------- ------------------------------ ------- ----------------------- - ------------------ --------------------- - FINAL INSPECTION BY _""_ li ---------------------- Date-------- `1. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Sycamore Street Sock+on, California 814 North "C" Street � Lodi, California Manteca, California Tracy. California ES-9�2M 3g5-0g6 n"rwono i $-Sq