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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued !YZO gplicA a-1-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 h County (;rdinance No. 5,4,1�v F &X11 M+,-U 04A TION__! _Ae.4#-a4,_R4_'W4J JOB ADDRESS AND 6�tq A14--y---47 A� --------------------- Owner's Name -----------------------i------------- ------- -L:t�-------------------- _------------------ -------------------- -I Phone-A-44f,00------ Address----------------------- --- --- ---- Contractor's Name--- --- - - --------- --- --- ---- - ------ Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court C] Motel E] Other 0 Number of living units: __/--- Number of bedrooms __!Number of baths __/---Lot size __._1--h...... -------------- Water Supply: Public system E] Community system [I Private [ pfh to Water Table ft. Character of soil to a depth of 3 fee+: Sand 0 Gravel [] Sandy Loam E] Clay Loam E] Clay E] Adobe�arclpan E] Previous Application Made: Yes F-1 No �ew Construction: Yes E] No li,' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted if public sewer is available within 200 feet.) Septic Task: Distance from nearest Distance from foundatio'n--/40. -...MaferiaI----- ------1=14 No. of compartments------9,--------------- Liquid depth----- ------ I-- 64'o"m foundation----Z6--------Distance to nearest lot line........e'jo- Disposa Field- Distance from nearest we�l_/"._. ._D'6fance 141,il�j Number of lines----of /----------t------ Length of each hne__raT'V__ ---Width oftrench r filter Type materiaI__!_ !V%_A Depth of filter material- -- Total length-_ "_z-------_-__. ------- ------------- Seepage it: Distance to nearest well/. ...........Distanc foundation/__j______ Distance to nearest lot line__ ------------ 961— Number of pits..-f------------- ---Lining material r,01211__.----.Size: Diameter_0.3�1-- ----Depth-- ---------------------- 3 Distance from nearest well_................Distance0 f _ material-__.__._.___-_.__..____----_--.__--__. P I Cesspool: from foundation--------------------Lining El Size: Diameter--------- --------------I------------Depth---------------------------- ------------------Liquid Capacity- --------------------------gals, 000 Privy: Distance from nearest well-................._.______._.--------..--_----.-Distance from nearest building._---.--____-.___----_--__._._---._..---- 4 ❑ uilding---------------------------I-------------- 11 Distance to nearest lot line' __------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):- --------- -----------------•-•-•---. - .r ------ ------------------------------------------------------------------- -------------------------------------------------------------------------- .... ---- - V ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------- ---------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I here rtif that I have pre red this application and that the work will be done in accordance with San Joaquin County ordinances, a ws, and rul an ulafions of the San Jo juin Local Health District. I (Signed)-------- ------ - --------- --------- ---------- - -------- -------- -- ----------------- -- ------ Contractor) ---- ------- .... By:----------------------------------------------------------------- --------- --- ---- -----------(Title)-- ---- -- n race -------- re� wells, building- - Pfc., can be d In side). (Plot plan, showing size of lot. location of system in rel n to FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -- ------_4 ------ - - --------------------------------------- DATE------- =Tc ------------- REVIEWED ATE-------- ------------- REVIEWEDBY-------------------------- ------- - ---- --- ------__--------------------- ------------------------------------------ DATE--------------- BUILDINGPERMIT ISSUED------------------------------------------------- -------------------------------------------------- DATE--------------- Alterations and/or recommendations:-. .-------------- ---------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- _1 ------_-- - --------- -- ---- ------------------------ L — . i ----� .1-___(------------- --------- ------------------ --w—A V I �� 14� , ..--! i-------------- - -------------------------------------- ---------------------------- it , P --------------------------------- --------------------------------------------------------:....... %,......I------------------1---------------------------------------------------_---------------------------------------------------- --------------------------------------------- ---------------------- ----------- ---------------------------------------------- -------------------------------------- ----------- ------------------------- FINAL INSPECTION BY:..-----.v Date-_ _-------/_f -------- --------------------------------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stotkfon, California Lodi, California Manteca, California Tracy, California r5_9_2M 145446 A7WOOD 12-54