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13) 1 + APPLICATION FOR SANITATION PERMIT Permit No. .3- __z'.�____. (Complete in Duplicate) Date Issued Application is hereby mad 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. 1 JOB ADDRESS AND LOCATIONS = L L. -----•---------------- Owner's Name---------- - '9 N4- ,S------- 2 1-rte-- �f _. ,: _ Phone - — Address_.__._...... -----------•- '±--V--�-------------------- ---------------------------------------------------------------------- ---------------------------•------- Contractor's Name 'Yt/ .r---------------------------------------------------------------- ---------_-., Phone---------------------------------•- Installation will serve Residence 5Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/--- Number,,of bedrooms_..--?7 Y umber of baths _1____ Lot size ._____---.J a_' ._�_b___________________________ � - � , Water Supply: Public system 'Community-system ❑ o,,Priyat e!❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet:1I Sand ❑ G e❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe b;( Hardpan ❑ i { k Previous Application Made: Yes ❑ No E4, New Construction: Yes ❑ No f � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F jtic Tan Distance from nearest well___________.__IDistance from foundation_____________ _____.Material_.____._____....--_,____..________________._____- No. of compartments--=-------------- -- --Ig Size------------t --------- ------Liquid depth---------------- ---- --_-Capacity----------------------- pos Field: Distance from nearest well---_7777.Distance from foundation-Ip. .........Distance to nearest lot 4 �. s line____s� Number of ----€Legthof each line--- -------- ----Width of french----------�-q-!............ or s iter material_Sl � rBepth%of filter material---------f__C?_ ----Total length----------------1.�_0---------.----y Seepage Pit: ;stance to nearest wall_:__________ ®istance �r�,/#oundafion___________________.Distance to nearest lot line____._.______.. ❑ . umber of pits----------------------Lining mat 'µ material Diameter---------- - --< __-Deptn--------------------------------- Cesspool: -- Distance from nearest well-----------------Distance frgm'f u dation._..----_----_ ----.Lining material------------------------------ II [] I ize: Diameter--- ----------------------------------Oe pth--------------- -------_-=._--—_ _�Liquid Capacity----------------------------gals. Priv Distance from nearest welL____..�_.__ ._�___ _________________ --._Distance from nearest!buildin _____. Privy: ------------------------------------ ❑ r I f --------------`-------------I- Distance to nearest lot line �- € Remodeling and/or #epairing (describe)-------------- ----------------------------------------------•-------------------------------•------------ ----------------------------------------- --------------------------------------•--•------------ ------------ -f- 1 ----------------------------- ---- = --------•--•--------- ---------------- a --• '------------------------------------ I hereby certify that 1 have prepared this applicati� and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of the San Joaquin Local Health District. I i (Si By: 4 ......./�`{/✓t / = (Owner and/or Contractor) ..."'-------------------------- {Title}Vie' ---------------------- [Plot plan, showing sizef lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. r. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----------------- -- ----------------------------------------------------------- DATE--------- ---------------- REVIEWEDBY.- ------ - -- --------------------------------------------------------- DATE--------- ---------•--------------------------------------- BUILDINGPERMIT ISSUED-----------------•-----•---------------------------------------------- ------ DATE-------------------- ------------------------------------- IAlterations and/or recdmmendatians:---------------•-~f----- ------------------==------------------------------------ ---•------------------------------------ i FINAL INSPECTION BY______________ l _!/___ _�__--r__��_�_. ..:�_ ------------ Date--------------- --- --f----- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street + 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sock+on, California Lodi, California Manteca, California Tracy, California ES--9-2M ic-52 Revised W-2100 1C