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APPLICATION 'FOR SANITATION'PERMIT Permit No. )6 (Complete in Duplicate) / Date Issued 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 LOCATIONf.{/ (/ l�S ---- ---- _- •----- ----------------•---------------------- ---_----=-------------------------------------- U Owner's Name • / , '� ---- ---- -_•---- .__ Phone Address--- �� 5= - - -- - - - r,� -------€-------------------------------------------------------------- Contractor's Name'----- �f „ � r------------------------------------------------------------------------------------------- Phone... ��4�� ---•--- Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ Trailer�Court ❑ Mote{ ❑ Other JK Y , Number of living units: Number,of,bedrooms ,______.,NumberofYba hs�__._�..., Lot size ______ a�Ksd' i ❑.. _._. _. ----------------------------- Water Supply: Public system C6m`-munity-system ❑ ;Private Depth to Wafer Table_ d ft. Character of soil to a depth of 31feef -S61 d ElGravel L] Sandy Loam E] Clay_Loam El . Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No f$ New Construction: Yes 0 No ❑ { �° TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted if Public sewer is available within 200 feet.) :x .. . i ... . ,� Septic Tank: Distance from nearest we}I- _�_____�-- Distance from foundation__.----}-._------ aterial__._4/ ._ f S4",Ve/ E�5.r No..of compartments------------------------Siz'e-------, ------------ -Liquid dep? h --_y ------ -_. Capacity___ Qo a.Q/ if * # a i Disposal Field: Distance€rom nearest rveli�o4)�Distance.from f,ounclation___�G_�___. .Distance to nearest lot line------s___..___ ® Number of lines----------�/---------t--------•---Lengfkl f each line-------- _'-------------Width of french-----2 y��--------------_----- ,s"" k Type of filter materiaL_S_:R_f� ______:Depth of filtermaterial.....f .��____-----Total length--' ength_�______34 ____________________ Seepage Pit: Distance to neaPest�well�_a______ _Distance from foundation r d ` _ - --- ---------Depth-------- -- _ s Distance to nearest lot line_S_ _______- p ameter-- ---�� r � �_S Dumber of its____ ___ ______`: _Linin material___________-_.-_ ____. Y } � i p _ b g c. i , Cesspool: SDzea Distance froe_nea esf Well--! r Depth Distance from foundation-- ---------------"__-Lining .material------------------------------------- . --------------------------------.:-_.. Liquid Capacity--------- -=--------------gals. _ -----------------------------------------------Distance from" nearest building_`____________.___'_ Privy:' Distance rom 'nearest well r ' ❑ �; ------ --------------- Distance to nearesfIlot line_or------- - '-` - - : r--- ,o == , - .,---. _-------- -r-.^- Remodeling and/or repairing (describe): -----== = # d s -----------•-------- --------- -------- ---------- �- { a -------------------------------------- ---------------- - ----- - ------------------------------------------- I - .- - - hereby cerYh haveP padthis-appli nork will-be done,in accordance with San Joaquin County ordinances, lawsandandrethe San JoaquiLocal.HealthDistrict. (Signed)--- ----- -- `f ----------------------------`---- }her and/or Contractor) sY: � ; P -:-- ----=---------- ------- (r+le)_ - k (Plot plan, showing size of lot, location of cyst in relation to wells, buildindt,_efc., can be placed on reverse side). I T FOR DEPARTMENT USE`ONLY' APPLICATION ACCEPTED BY----- -' DATE -�-�-- REVIEWED BY ---------- -----------------`. ---------------------------------------------=---�----------------------- :__ DATE------------ =--------- 4 BUILDING PERMIT ISSUED----------------=----------------------------------------------------------------------------=---=--- DATE----------------------- Alterations and/or recommendations- ---- -------- ---------------------------------------_ ---------------------•------------- •-----------------------..---------------- ----------- -----------------------------------------------• ----•---- ---- •-----------------•--------------------- ------------------------------------------------------------------------- ----------------------------------------------_----------------------------------------___------------------_---------------------_-----------_______------___________________________________________________________________ '1 ` -------------------------_--------------------------------------------•-- '--"•---------------------'---------------------------•---------------•__-___._ ----------------"-""---------------------- ------ A I %- FINAL INSPECTION BY: ----------• --------- -------------------------- '.. ... _. Date- _. ' = _ �' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh'American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ;k-.Sfockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100