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r 0 APPLICATION FOR SANITATION PERMIT Permit No. .2 (Complete in Duplicate) Date Issued E02g-�30 31 Ag is herebylmade to the San Joaquin Local Health District for a permit to construct and install the work herein described. 3®� j t�LO`id dad cram; lien ce ith County Ordin n e No. 49. application - p - -- = JOB ADDRESS DLOGATIoN./_� :Ah- - ------- ------ - --'----- ----- --- -`;` w ------&,A�, - Owner's N e. • F= _ Phone. ---- ------ Address.-.- ). ---------- '-------- ------------•---•- ----------------------•-- ---------------------------------------•-•------------------------------------------ Y i 3 Contractor's Name---- - ------ ------ - -•--_------------------------------------------------------•------------------------------------------- Phone------------------------ ----- r � Installation will serve:-~l.Residence ❑ 'Apartment House ❑ Commercial [j Trailer Court ❑ Motel ❑ Other Number of livirig units: ------ umber of bedrooms -------- Number of baths _ __ Lot size -- _i�_®__ - ---------------------------- Water Supply: Public systerriCommunity system E] Private ❑ Depth t Water Table -------- ft.' �— Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe F] Hardpan Previous Application Made: YesEl No e New Construction: Yes eNa ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.} . . e�� r Septic ank: Distance from nearest well. -U3sta c fro four tion.___ __ ____.__-- ater atJ__-------------------- t No. of compartments---------- -f____ -_Si e�. Xd- YAW_Liquid depth---- -- -------- ..Capacity._- _- s I W DisposdP Field: Distance frorn'neare well Distance from foundation__ __. _ istanceft+rneahrest to ino-__:--- --' , Number of lines_____%-. _ ength of each line_______-_._.---- Q _._. idth o e Type or' filter mater _. _�_ Lepth of filter material_.__.._-�-___.__.Total length_Q�._-�� i 4 Seepage Pit: Distance to nearest welf_,_,_.---------------Distance from foundation--------------------Distance to nearest lot line--..--------___. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------_---------Depth--------------------------------- 11esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------------------- Size: -.________-----.-----.--_ -_.Size: Diameter------ -----------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance Brom nearest well------------------------------------------------.-Distance from nearest building.--.-.-.--.-_-------_-----__-_______-----. ❑ Dis"tance to nearest lot-line------:_------------------_------------------I--------------------------------------------------------------- --------------------------- X Remodelinganti/or repairing (describe)-----------------------------------------------------•----------------•--•-•------------------------•-•--------•-•--••--------•-••---------------•-------- � i •------------------•---•---------------•--•---------•---- •--•------------------------ -•-••--------------•--•----------------- t' = ' -------•----------------------•-------------------•---------------•-------------- -----••---------------------------------------- L I•hereby certify that I have prepar this application and that the work will be done in accordance with San Joaquin County Ordinances, State I s, and rules and r guiation o he San Joa Lo -- cal Health istr ct I �.. 1 Signed)---- ------- - ------- -- ----- ----- ---------------------------- -- - - --------- - `---- -- ------ ----- - /or Contractor) e Ti#1 ---- By:......--------------=-- = -------------- -------------------------- } (Plot plan, showing size `f of. location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY t ----------------------------------------------------------•----------------------._ DATE,---•---• ------------------------------------------- REVIEWEDBY ------------------------------------------------------- DATE -- ------------------------------------------- BUILDING -------------------..---------------------- BUILDINGPERMIT ISSUED----------------------------------- --------------------------------------------------- ------ DATE.----- . ---- -------------------------------------- Alterations and/or recommendations:-- --------•------------- - --------- ------------------------------------------------------------------------------------------------------------------------ --•---•--•--------------------------•- 4 �. -----------------------------------------------------------A.-_._-._-_--...._.-._..---_._-.---.-_-.._-_--.-._-___.-._-__-----.-_-_____--_-.-__---_--__......_.._______....-----------------------------------------------------. F ------------------------------------------------------------------ lep FINAL INSPECTION BY::. .___ - - ---------------_-----` Date_.'.�.��_�.�s-- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Sock+on, California r Lodi, California Manteca, California Tracy, California E!3-9-2M 145445 A7WCOa 12-54