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Z`` b APPLICATION .FOR SANITATION PERMIT Permit No. .{7......... (Complete in Duplicate) Date Issued Application 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 `�-©-� !_- V , L1__1_ y`- r Owner's Name------------------------------------ _G71C� ---- L----- ---------------------- Phone-- `2- c0/7••-- Address------------------------------------------------ -- J1------ ----- Contractor's Name---------_-------------------- ------------------------------------•---------------- Phone---- �� 'p Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [g.��} PA Number of living units: __:----- Number of bedrooms -------• Number of baths --/---'Lot size ----- l-__-_/__07_p.---___-___.___.-_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table4ft.� ro Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe]a Hardpan ❑ Previous Application Made: Yes ❑ No�4_ New Construction: Yes ❑ NoE]3, TYPE OF INSTALLATION AND SPECIFICATIONS: / �J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se 't T kms' Distance from nearest well-----------------Distance from foundation----_---_-__-------.Material----.___________.__-- _--__-.-------------_.-. ------------ Capacity----------------------- � No. of com artments. __-.Size_ Li uid de th.-.-_ __ ._ Dis osal FIdDistance from nearest we1_ND- 9_.Distance from foundation___.XO__ to nearest lot line-- ine-_ 1 '- y 0Width �____r.•_ .-_-_- _ � Number nes.-------- ------------- Length-of line - ------_------ otrenc ------ ) - O Type of filter material-- -- �� - -- p � length .- De th of filter material l_�-----------Total ___.____ Seepage Pit: Distance to nearest well-.N4NC'-------Distance from foundation-7--0`_......Distance to nearest lot line__-_'r _�__ [ Number of pits.._-----------------._Lining material--- _..Size: Diameter--- _'5 Depth__1_`54_'_-_._---.__.___.._ Cesspool: Distance from nearest well------------------Distance from foundation------_-------------Lining material---------.--------------------.---.--. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building.-._.-_---.--.______________-.._-.--.-.-. ❑ Distance to nearest lot line----------------------- --------------------------------------_-------------------------------------------------------------- ------------- - _ r Remodeling and/or-repairing 9_._:. --------`'�w" ==----------•----------------------------•-•---------- ------------------..---------------------------........ _ - .v ------------------------------------------------------------------------ ----------- `" --_------ ------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------k•---------------------- I he certify that I have prepared this application and that the work will be done in accordance with San Joaquiis County �G1�frp �e Sa Joaquin Local Health District. S ordinances,n d State laws, and rules an re ns of- pr 9 } t { Contractor) By:-------------------------------------------- '---------------------- -- -----�`-��i'----- ----{Title)--- tr1 -------------- - (Plot plan, showing size of lot, location of system in relation to wells buildings, est , can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------- DATE3 REVIEWED BY------------------------------------------ ------------------------ DATE---- ----- ----�-W-ter-�- - ----------------------------------------------------------- - - --------------•----•------- BUILDING PERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE----- Alterations and/or recommendations------------------ ------------------------------------------------------------------------------------------------------- ------------ ----------------------- i ------------------------------------------------------------------------------------------------------------------------------------------------------•--_-_._------..-_--.--..__,,..--__.._--_--._-_----__----__-_-._.-.--___- I I FINAL INSPECTION BY:..........��-'-�3-,�� ------------ -------- Date--- �-- .�'�---- ---------�---------------------------- �------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100