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�\ Permit No _-_• APPLICATION FOR S ' ----- �q ANITATION PERMIT �. (Complete in Duplicate) Data Issued _!.�.M � � 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. 54 JOB ADDRESS AND CATION_&"4".-- -`-""" r 1-1 pol Owner's Name-------- /. ----- f Phone- - r0 Address----•-------------------0.� .....- - - � ------- Phone- • _,o---------• -•- - • - ._�-------------------- Contractor s Name----------------------- - •- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of baths '-_- Lot size --- - ��- -/----------------------- Number of living units: __�_-- Number of bedrooms -- • _ - Water Supply: Public system-'[►"Communify system ElPrivate.❑ Depth to Water Table ' �_ ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay.Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No 2New Construction: Yes Er-IN-o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T ki Distance from nearest well 2f0A1"_Distance from four;dation--I4----------Material--- �'-_!C� .- ----- No. of compartments-_---- -- -}Size__1_C jg Liquid de th----�d-------------Capauty._��l.lam . - --_.Distance to nearest lot line,-------_- s Disposal Field: Distance from nearest weil_� istance from foundation_.!D f� of`lines----------- ------ --- - -- -Length of each line------ r�-. 4-------,F-----.Width�of trench---rZ-5-___----------------- Number � Type of filter material-S'[- e G -Depth of filter material-'l_- -__--_,_..Total length------,77L7.4,,_ye-) jype Seepag it: Distance to nearest well��(! _�--Distance from four ation_-_-- -••_ -_-_--.Distance to nearest lot line----------------- Number of its..-.-- _--� Linin material-Si.-Size f Diameter----33-��__-.--Dept'n---- 5^ ----------------- -� k 21 Cesspool: Distance from nearest well-----------------Distance from found.ation------------------. Lining material----------------------------_-__------ Size: Diameter----------=------------------ -------Dei'th-------------------------------------- ------------Liquid Capacity----------------------------gals. , Privy:❑ Distance from nearest. well---------------------------------- ----------#...Distance from nearest building._--------.-------_---------------=------- ❑ -------•--- El ---------------------- ------------------------------ ----------------------------------------•--------------------- Q Distance to nearest lot ine--_--------------=------ Remodeling and/or repairing (describe}--------------------------------=-------------------------------------------------•------------ --- ------------------------------------------------------------- ------------- -----•-------------------------------------- ------------ ------------------------ c ,.. ---- -------------------------------- ---------- f - ----------------------------------------------------------------------------------------- --•------_------•--------------------------------- -----------•_-_-•-----...----•_----_•------_-_•_-_•---------------•-------_ - ! hereby certify that I have .prepared this application and that the work will be done in accordance wifh San Joaquin County �- ordinances, Sta a s, and rules and regulations of the San Joaquin Local Health District. - - i ---- -__ ner and/or Contractor) (Signed) --------------- --------•----- -------------- - -- - - i By:------------------------------------------- � � - ----------------{Tit! st (Plot plan., showing size of lot, location of system in relation to wA Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- "s---------------- -- -;- ---- = --=------------------ ------------------- DATE------------------------------------------------------------ lY/ DATE_-� --- Y''� ------------------- REVIEWED BY------------------ ------------ ----------- ----- - i -V f BUILDING PERMIT ISSUED--------- ---•----- DATE._. Alterations and/or r commando 'ons. ----------------------- - ------------- -•-�` �---- ----•� -----(� -�( l -1-�------ -- --- ---•-----------••- ----- •-••----•------ ---------- ---�--` - ------ ' -�-� ---------- ------------ 9 -------------------- ------------------------------------------------------------------------- ---------------------- ----------------------------------------------I---------- 1/2 -.�c� - - _ Date.. - 1 ----------------------- FINAL INSPECTION BY:--- -----:-/ ±...---- - -- 0/ - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT (3 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y SMan+eco, California Tracy, California tock+on, California Lodi, California E5-9 - 145446 n7WOOD ,._.