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'~ APPLICATION FOR SANITATION PERMIT Permit No. . [Complete in Duplicate] Ito Date Issued -----1��S------ Applica{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. L 2'f2f� 2`i.r��t-ckc:J 4�{ I JOB ADDRESS AND Owner's Named-� F------ tJ-�1.,r1�---------------------------------------------------- -- ------•-------------- ~ Phone. AW Address tl 7— / Zz -241 .................... Contractor's Name—.51,14n f�-------------•-------•---------------------------------------------------- -----------•---------- -_------•"--------Phone" Installation will.serve: Residence' El Apartment House W Commercial ❑".Trailer -Court ❑` Motel ❑ Other E]Number of living units: -16---- Number of bedrooms 61. Number of baths .(jD.-- Lot size-____1_QZ) _.2" -_ -------------------- Water Supply:. Public:system E] Community system ❑ Private f( Daepth to Water Table .*-b ft.- Character t.Character of soil to a depth of 3 feet: Sand I( Gravel ❑ Sandy Laa Clay Loam`❑ Clay [:1 Adobe❑ Hardpan ❑ "Previous Application-Made: Yes�❑t No El New Construction,: Yes No❑}, TYPE OF INSTALLATION AND SPECIFICATIONS: .. (No septic tank7or cesspool permitted if public sewer is available within,200 f 11-4 Septic Tank: Distance from nearest well t.-__Distant fro ' found tion__ ✓ ' .Mate �1/G_l��;r'dr_._T,r�i�+-- No. of comportmems___f__k�/ t_.........Size_ `. _,Liq Fid dept{i..__�-_'-----------Capacity-A160-0_ Dispos Field: Distance from nearest well---+040-------Distance from foundation__` j- • Distance,to nearest lit line___?Q-�___ Number..of lines:'.____ _Length of each bine-- -,dam.___-__ -_r ' :_._ T-Ik1�l.'I~----- ----------- g � Width of trench-4-4 ------•----•-----"---- Type of filter material_ _:_____Depth of filter maf�?6;1___46- �`-- Total, le'ngth__,R.0l? Seepage Pit:. � Distance to nearest well_"________________r�.Distance from foundation______________:_.__.Distance to nearest lot line__________...____ Z ❑ Humber of pits- Lining material ----------------- Size: Diameter.' Deptn Cesspool: Distance from nearest well______________" Distance from-foundation---.--__-.____=__Lining materialE_____-_____.________ ❑ Size: Diameter , Depth . ;�-- �--- �.... �.._. - - p_ ---Liquid Capacity' ------------------------gals. Privy:' Distance from nearest well______ _ _ _______ -- ______-____ ___._Distance from nearest building_ -------------------------------------- Distance ___.__._._ ---------------------- Distance to nearest lot line---------_-------------------- ' ------------------------------------------------ � . Remodeling and/or repairing (describe):_,�_.11r/ 10_ __-� _ f,(-til/�Q- [_--_4-A'NX1'/?(K;ri0-.4/ Ov( R1" ----low 1'"�r�ar!'I I hereby certify that I have prepared this application and that the ork will'be don*,th-accordance-vAth San JoaquinCounty ordinances, State I s, and rules and regulations of the San Joaquin Local-Health:District.- J4 (Si ,.. gned) - -------------------------- ------------� ---------------------•---------------{Owner and/or Contractor) BY: = ----------------------------- -----------------------------------------------------(Title)-----------1---------------•------------------- --------------- (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 s APPLICATION ACCEPTED -�__ �� -- -------"-------- DATE------�---- ••---1 - ---------------- REVIEWED BY------------------- ------ ---------- DATE BUILDING PERMIT ----------------------------------- ISS�IED_... - --------------------------------- DATE_----------------------.- ---------------------------- Alterations and/or recommendations---------------------------` YY-------- e- - - ----_- - '=S ------- , e a 1 �_p J 1df----------------------- , - ---- ------ t 4 FINAL INSPECTION BY:., f ------- - -------------- Date--------� C / `7�r��—� � 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 132 Sycamore Street 814 North "C" Street StOCktoa, California Lodi, California Manteca, California Tracy, California " ES-4 2M Revised W-2100 d