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N, G y\yAPPLICATION FOR SANITATION PERMIT Permit Na. (Complete in Duplicate) Date issued --------- ., VAr 1Y, .Appl'ca*ion is hereby made to the SaniJoaquin Local Health Disfrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. k - +' ffjrlM _". --- "--__---"" --•_--__-"-"-------------------------"---- F r __"Y"-. R _ -_ JOB ADDRESS AND OCATION--------------- phone -":---" - - ----- -------------------------- --------:--------._--- -Owner's Name----- ----- + - ---=----------•---------- -•------------------------------•-------------- Address - 8p---.--- (,,�. � Phone :. --- Contractor's Name-------------------- - --- - .1 13 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Mosel ❑ Other !i __ Number of baths "_L.-- Lot size ---- �-Xl-D-a----- Number of living units: ---/-- Number of bedrooms . t. Water Supply: . Public system ❑ Community system �f"rivate ❑ Depth tClayaLoama❑ Clay f❑ AdobeHardpan ❑ Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam ❑ Previous Application Made: Yes F1 No New Construction: ' UT Yes 1/� �`o El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 fee/t.} __Distance from foundation--._/_-LQ---"-._-.Matena4-- Septie Tank: Distance from nearest well� lt"n� pOD__- No. of compartments -- Size.S� j�-. Liquid depfih Capacity.."f Disposal Field: Distance from nearest well--Distance from fouridation---P� �......Distance to nearest lot line_- -_e- p� / Length of each line-----_--�-5�-------- .-.Width of trench----v7 jY-��----------------- 1J' Number of lines-_-.--�--"------- g Type of filter materials,. .y�-��--Depth of filter material-.__-1 - .------ Total length""_."7 ------- Distance from foundation__,_ 4':-----.Distance to nearest lot line"-5.�------- Seepage P' ' + Distance to nearest well_..�f/>Z�- j Number of pits-.'--1--------- -Lining material-_ A Size: Diameter---. ✓'-------------Depth- _ P ----------- ---•-- i ------- Cesspool: Distance from nearest well-----------------Distance from foundation -. "._. Lining material---___-.-.-" gal -------De Dept ---------------------------F -- s._ ElSize: Diameter---'--�- ------- -----�-- .- p -- ----Liquid Capacity----------------------------- \- TDistance from nearest building----------------------------------- ---- Privy: Distance from nearest well-------------------- -- , Distance to nearest lot line---------.---------.-" ------------------------------------------ g nd/or repairing (describe):---------------- --- -------------- ----- E --------------•---------- --------------------------------------------------------------- ----------------•-------=-----•---;--------------••---•---•- I I hereby certif ce rtify a dhrules andaregulations application the San Joaquinthe Localwork HealtheDis#r1c}n accordance with San Joaquin County ordinances, State laws, --------(Owner and/or Contractor} (Signed ne9 . }------•-- •-- -•--- ---�--••-•- �� - --- ------- --(Title}---- -{ --------------------------------------- Ar Plot plan. showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY ` jDATE-- ---------------------- ----- --------------------------------- APPLIGATION ACCEPTED - _ -�------ ----- -�----� ------' -�---- �- DATE--- ----�------------------------------------------- REVIEWED BY------------------------------- ---- ------------------------------------------------------ DATE ;----------••---------------------------------- BUILDING PERMIT ISSUE -"-_-".--"----- rec`o endatio s: F' ----------------------------------------- Alterations --------- ------ --------- Alterations a1 si./ Q -''r-": -------------------------------------------------••-•------•-- - ---------- -- ----.C4 r�. n-----•---- -------- - 7 ------- FINAL INSRECTION BY:." "-"-. f -- ------ ------------------------- ------- - .� ,.. — Date 1 �"-- -.�..""� �- ------------------------------ SAN ---------- ----------SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street_ 814 North "C" Street 130 South American Street 300 WOO Oak Street Trac California S+nekton, California Lodi, California Manteca, California Y' 145446 A7W1710D ..