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APPLICATION FOR SANITATION PERMIT Permit No (Complete in Duplicate) LCL Date Issued t�e wop�I Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and msFa71 the work herein d scribed. This application„is_.made%in-comp[iancerwith County Ordinance No. 549. EZZU(�«W ttJi4SFr�J 6�C7iJ JOB ADDRESS AND jATION___ Owner's Name--- Address-e-,_0 ame___ _ : ( ----------------------------- 4a ---------- Phone.- ----- s -- - � 2 Address_. t --- ------------ r :7 Contractor's Name i = . - ' Phone f ------ of Installation will serve: Residence ❑ Apartment H ❑ Commercial [] Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedrooms 40._ Number of baths ._,/---__ Lot size Water Supply: Public system Community system E]. Private ElDepth to Water Table=_eft. r- ' Character of sail to a depth of 3 feet: fSandGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay'O Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction:,Ye�sv No ❑ TYPE OF INSTALLATION AND.SPECIFICATIONS: , (No septic tank or cesspol permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weft `_Distance from foundation____ _ Mat erial_--� �-- � -No.,of.com artmants__._ ____. Capacity �_ I ---------- f Disposal Field: FDistance from nearest well �r'i� ”-Distance from foundation--___ l Distance to nearest lot line_____..___ Number of lines_` __________________ __"____Length of each line______ __ __.Width of french.......2-1_-_- ------------- Type See a ePit: I Distanocaftloenearematerial - -- -- -- --------Depth of filter maferial_____- - ------Total length______ __ p.5 Distance from .f undatipn___,-, _---__-.D' t�nce to nearest lot 'ne ""___._. st well---- :D`wl�--- Number of pits._-.--- �y �___________Linin matenaL_ w '`._5iiei'Dirnefier_" Depth _'_." = --- Cesspool: Distance from nearest well--------------_-_Distance from foundation--------------------Lining material-____._____---_ C -s— .; ize;-Diame#er_� f:_ _:___ -. -` - "Dernth �` Li uEdCa aci ? . _- .. q P +Y k Privy: I Distance from nearest well ---- + -____---._Distance from nearest buildin 5-------------- ❑ ' # Distance to nearest lot line---------= " = A � r _F -------------- - ------- Re deling and/or repairing (describe):__-___.��`;-_ _ r - 4 � s ... --- Widw ez � ---------- ---------------------------------------•------------------------------------ i , ----- 2 I ereby certify,that I have prepared this application and f the work will be done in acc rdance with Sa oaquin County ordinances, StatDiandd rules and r gala+ions of-the San Joaquin Local Health District.(Signed s------ ------- - -- --- -- , ' - wner andd/,or�Contractor) By:----------------- --- ----------•---(Title)'__._. . � - - - � (Plot plan, showing size of lot, location of s min elat' nj�o wells,�buildings, etc., can be pCd on reverse side' ). #r i FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY------------------------------------------------------------ LL ,,�� .DATE �/ 1 REVIEWED BY--- l = i/ DATE -.-!- �•• ----- BUILDING PERMIT ISSUED ffi 'DATE--------------- Alterations and/or recommend f* ns____ _ _ ` — G.d. - __ -------------------------------- -----•--------- --•---------- ------------ ----------------------- k FINAL INSPECTION BY ... 1 ------------ --------------------- ,Date-.---------- SAN JOAQUIN LOCAL"HEALTH DISTRICT �- "-46 American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ,_ i Lodi, California Y� Manteca, California Tracy, California