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i APPLICATION FOR SANITATIONPERMIT Permit No. ----- — ------- (Complete in Duplicate) Date Issued .... ........ ------- I Applica4-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 ..................... .......----------------------------- OB ADDRESS- AND LOC 10 ....... owner's Name ----- - ----------- --- - _4,ZU ------------------ ------- .... ..... ---------_------ ................ Phone— .......................... ------- Address..........J --- -- - -- ------- --- - :----------------•---• _� ---------------- ------- --------------- - ----- .................................. ................ Contractor's Name_ ............... -------------------------- ------------ ------- ---------- ........... Phone ............. -----------_------- Installation will serve: Residen e Apartment House E] Commercial E] Trailer Court [] Mof,71 F] Other.0 Number of living units: j.... Number of bedrooms -a--- Number of, baths .4... Lot siU ...................... Water Supply: Public system [] ,Community system [3 Private Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand E -Gravel EIrSandy Loam [ Clay Loam ❑ ECly ❑ EAdobe Hardpan VC 4 Previous Application Made: Yes Ej No V New Cons4ucfiori: Yes VN, Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool 1p�ermifted if,pukilc sewe is available within 200 feet.) MA) Septic nk: Distance from nearest wel' )!)�_,�Deis�f'ance from foundafionto_"aferial .... .. _jt. "T'S, /2119 No. of compartments..---_-- & S i . . ................................ Liquid e th ..... Capacity-_-- - .. 7, P. ----------- Dispos� Field: _M Distance to nearest lot I' Mitance- from nearest 04 ............ �_Disfance from founclaflon-W.- I es 71 Z Length of each line-_-.___._ 7-51-9 ..... Width of trench_._-----_ ------------ Nu-mber of lines_._______ - --------- ---- Tye of filter mater epth of filter material _- length ------------ --------- L ...... p Disfancq to nearest lot 1-5 Distance to nearest foun�a line SeepnclWPif: i, 111117.09 --------------- Disfanc,6&o.� ----- 7 --------- Nu-mber of - pits.-...............__ Lining material...,.. ........ Depf h .......... 1-71,07 ........... Cesspool: Distance from nearest well ----------------- Distance from foundation ............ ....... Lining material_....__...._..__.-_--_.-__-_---._ --- ❑ Size: Diameter -- -------------------------------- __Depfh -------------- ...................... ...:.._......Liquid Capacity. ------------------- .gals Privy. Distance from nearest well .................. . ___...-_...._..._.....Distance Distance from ne6re'st building........-_.__.-.___.._--_. -Distance to nearest lot line ------------- ------ ------------------------------------------- ........... : --------------------------------- --------- Remodeling and/or repairing (describe}---- .......................... ------------------------------------------- -------------------- ......... t ........ ---------------- ........................................ --------------------------------------------- ------------- ........................ ........................................ --------_------------------- ---------- ---- ------------------- ........ 1--- .................... ------------ . ------------ ------- ---------------- .......................... ----------------------------------------------------- ........... .................. I hereby cert' at have �repared this applicat' n and that the work will be done in accordance with San Joaquin County Stat rules f f tions , f ordinances, Sfaf la s a ' rules'and re ions of San Joaquin Local Health District. (Signed).. - ------------- ---------- ......... (Owner and/or Contractor) - ------------- -- ----- ------- .. .. ..... .......... ------------------------ BY: -------------------------------- -1 - _i_ _ ------ ------ ------------------- -------------------- (Title) ------------ __ --------- ------------ -------------- -------------•--- --------------- -ze of lot, I cation efc-,"can be placed on reverse side} (Plot plan, showing she of lot. , a ion of system in to wells, buildings, FOR DEPARTMENT USE ONLY 1A APPLICATIONACCEPTED BY -----------.----......------................I......_.. DATE: - R--..----••-------- ---------------------------------- REVIEWED BY_ -------------- ---- * ---------------------- .............................. ................... DATE -..:....---....------........----•---.I........ BUILDINGPERMIT ISSUED. ----------- it,/\ ----------- ----------------------_--------- --------------- _ DATE --------C, -------- ------------------------------ Alterations and/or reco m mend aflons: ............. ---------------------- ----------------------------------------------------------- --•-------••-----------•-------------------•-- -- ... . . A.0 ..---- ... ........ ------- ----------------- ----------------- ...... ---------- ------------------- .......... ......... __ ................ .... . ..... .......................... ........ --------- -------- __ ------- ------- ---------- --1 ......... --------_---- ............................. .......... ........... .................... ................ ............................................ ----------- ------- --------------------------------------•-----•..........-------------........................... ------------------ .......... -----------------...---------..-..------•------•----------------- FINAL ..... FINALINSPECTION' BY:----.....-. ....... ......... ............... ............. Date-------- ---------- .......................... ........ .................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A. Sfr,4z+ 132 Sycernore Street 1 314 North "C" Street S+oci+on. California ' Lodi, California Manteca, California Tracy. California E r_G 14S.446 A7WOMO