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�l} APPLICATION OR SANITATION PERMIT Permit No. °]\`�, in Du' licate) 3 (Complete p Date Issuedte� Appliceicn 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. .� ---- ---- ---- - JOB ADDRESS AND LOCATION_�j_ = /' ] Owner s Name---. C. _. ,Sri. t -------------------------------- - ... Phone--ice / ? ! - ,' -------- -------------- Address------- --_--•------------- . -�- --------------�----------------------------•-- - --------------- Contractor's Name. -e "" Phone______ ____________ - " Commercial Trailer Court ❑ Motel Other ❑ Installation will serve: Residence ❑ Apartment House ❑ ❑ to Number of living units: _ Number of bedrooms-: Y,Numbe.r„of baths _ Lot size / ...... -------------------- Water Supply: Public system Community system ❑ Private Depth to Water.Table3,, ft. a' I Character of soil to a depth o 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam [IC ±;.❑ Adobe Hardpan E] Previous Application Made: Yes ❑ No [�New Construction: Yes No El } TYPE OF INSTALLATION AND SPECIFICATIONS: . F ' (Na septic tank or cesspool permitted .if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_-_-________--.Distance from foundation________________Material-------------------------------- ❑ No. of compartments---- ---- ----------- 7Size------------"- --- =------------ ,Liquid de th '-`.. -- '--Capacit-_._'_7----- Disposal eld: Distance from nearesf well__...?._-.--Distance from foundat}on_ "_- _ Distance to nearest lot line.____ Number of lines"""--- ---- ��------"--Length of each line_--------f------ --.------Width of trench..� --------------------- Type of filter materiail� __"---I___ s%fl)epth of filter material__._d .._-._.-. -Total length___ -"""""------------------•- Seepage Pit. Distance to nearest well----------------------Distance.from foundation_____--------------.Distance to nearest lot line----------------- E ------ ❑ Linin material--------------- 'Size: Diameter= Depth Number of pits..---""-------- ----- g . - - Cesspool: Distance fromfnearest well-----------------Distance from.foundation...------------.-.__.Lining material._.__._-_-_____'-------------"--els. ❑ Size: Diameter----------------- ------Depth-------------------- •--------------------- : Liquid Capacity g Distance from nearest well-_-._...-_�"------------------------ "----'--#Distance from nearest building_._--____.__-_____---_------------------- �. Privy: r ❑ Distance to nearest lot line------ -- ---------------------------------------- � r yam, + Remodeling and/or repairing (describe:_. .___-.._. :- f Q+ ' �' d F ""- " --------- ----------------------- A•------------------------------------•-- ---—---------•-- ---- �"- ---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin,Conty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �a _ (Owner and/or Contractor) ata -------------- ---- ------- ---- ----------------------------------------------------------------------- (Si 9 ) BY= ------- -------•---- (Title) ---------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .f DATE------------ APPLICATION ACCEPTED BY_-.-- - - - ---- ---- - -- ------ --- --------------------------•------------- J ----- ----------------------- REVIEWED BY-------------------- --------------------------------------- DATE t - ---------- -------=---- BUILDING PERMIT ISSUED----------------- ----------------------------- -------------------- -------------------------------- DATE. - Alteratiops and/or recommendations--- ------- ----------------- ---- ----- - - ---••-----------•-------• ------•---------------- -------------•--------------------------------------•--------- --------------- _ 7 FINAL INSPECTION BY:_____ ________ _________ ----------------------do Date.... - SAN JOAQUIN LOCAL HEALTH DISTRICT f 132 Sycamore Street 814 North "C" Stree+ 130 South Ameriean Street 300 West Oak Street Y a Lodi, California Manteca, California Tracy, California Stockton, California ' EE-9 -544G nrwdno ,