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\� APPLICATION FOR SANITATION PERMIT Permit No. .___S_.9-31 -, (Complete in Duplicate) Date Issued _V?MA Applica+ion is hereby made to the San Joaquin 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. �� /. ---- ------- •------- - --------------------------------- JOB ADDRESS AND LOCATIO0 Owner's Name-----MX6F----+ -1 ------- ------ ------ ------------ - --- Phone _'- Address------------------- . - /' d .,_.. '------------------•--- , _-- Phone_.- - Contractor s Name-----------il�A-/_' GS �..! ----- -----------•----------------------------•--- lnstaNation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 10 - Number of baths ` Lot size -- -_ - X---f-�- - ------------------------------- Water Supply: of living units:------- Number of bedrooms __;� ! > Water Supply: Public system ©Community system ❑ Private ❑ Depth to Wafter Table Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: NC, Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- ❑F-xjS17 No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material----------- -------------Depth of filter material-----------------------Total length------------------------------------------ Ir -_-____________-__ _____________,--__._ _-Distance to nearest lot line_-.�__-____. Seepage Pit: Distance to nearest welL_/ Q1 , _--Distance from foundafiion____t/�______- �\ Number of pits_ /1zr_i�i-----Lining material_ R!W4----Size: Diameter_„��___.__..--__Deptn-- -------------------- Cesspool: Distance from nearest well_________________Distance from foundation-____.-------------Lining material----_______._____-----___----_-__ -. _Depth-------------------------------------- -----------Liquid Capacity----------------------------gals. 1 El Size: Diameter----------- ---------- '--------- " Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._______.._--_____---_------------------. Distance to nearest lot line------------------------------------------------ ------"------------------------•--------------------------------------- 41 Remodeling and/or repairing (describe}:_._ -- ---- -----•-- ---------------------------•------------------------ --- ------ --- -- --------••-- ---- k ........ ...... ` - ' ------------------------------------------- ------------------- --------- ---- - -- -- ------ ----•------ I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawn rules and re ations of the Sal aquin Local Health District. ----- ------------ By: ------- -------- -"------__+-_--------------------[Owner and/or Contractor) .�. .�. cif ' --- - ---Es�buildm s, et (T'tIe) - E By:. --- (Plot plan, showing size of lot, location of system in relation to g c., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- DAT ---- -- --------- --------------------------------- DATE----- ------- REVIEWEDSY------------------ -------------- ------ -- -- ----------------------------------------------------------------• "_�-------------------------------•--- BUILDING PERMIT ISSUED--------------------------- ----------- DATE----------_--- -- ----------------------------- ------------•-----------•---------------•------------•----- ---- ...........C Alterations and/or recommendations:...._------------ ------��_.-.-----------•-- ---�•--�------"-----"--- ••------------------------- ------------------------------- ------------ •------------ ---------------------•--------------------------•-------- f > 16 fes, Date ! --- ' FINAL INSPECTION BY____________ `--------------------- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California rc 0-1)" R^v7,Ae4 W-2160