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4. r` � APPLICATION FOR SANITATION � PERMI ,T Permit o. .._...__-- (Complete in Duplicate) . Date Issued ---- Applica-•ion is hereby made_fio the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compfiance with County Ordinance No. 549. ,�f JOB ADDRESS AND LO ATION___ _ "�"� � �, ��} /r'' - f11-�1 ---- Owner's Name------------ - -� --------•-•-- A dress----------- --•- ' --------- Phone------ - -- .. ..._ _ . s " ontractor's Name------------ --' - -- ------- --- - --•-•--•---- Phone------------------- - (nstallafron will serve: Residence - """"'""""'---' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_.-" Number of bedrooms%-?.- Number of baths -."/. Lot size ._"Z�t4' Water Supply: Public .s stem """ -------- PPY• y ��ommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 9�' New Construction: Yes 1�'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /� Septic Tank. Distance from nearest well._ _Distancelfrom foundation----4e"�_,""_.MatenaL_ -(`a- iJo. of compartments.__. � depth _- � --------------- -----------------Size-- I-/-Y-0-----.Liquid Capacity Disposal Field: Distance from nearest weil.. V_=Distance from foundation•- f -___-.Distance to nearest lot line.___I��•_" ]' Number or lines------- -----_""-------- Length of each line_...._ __ 9 `l�'`--- -- - Width of trench - Q?f---" Type of fitter material.�� lix r� -. --. _.- Depth of filter material__._ 0 --- --.-Total length_____-7-47-__--___ Seepage Pit: Distance to nearest well -_- :.:__-Distance from foun ation__l� s - ___-__-•.."___.Distance to nearest lot line___ __________ ( Number of Pits-------/--------.___Lining material_C4_ ° -. -Size: Diameter__1 'Ole -��--- -----Depth---- ' esspool: Distance from nearest well___. _.___Distance from foundation.-----"__--__.-__-.Lining-material"-__-".-__ ❑ Size: Diameter--- --------- ----------------------Depth------ ---------------------------------------------Liquid Capacity-.-------------------------- gals. Privy: Distance from nearest weli._. _--------------------_-_-----------------------------Distance from nearest building4 � ❑ Distance to nearest lot line___.__- = �V Remodeling and/or repairing (describe]_ _ \� ------•---------------------------•-----------••----------------------------- ---------------------------------- ------------•------•-------------------------•-------------------------••---------•--•-------------------------•-----------------------•--------------------•----•---------------•---•--•-•------------------------------- °i --------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County A- ordinances, State laws, and rules and regulations ations of the.San Joaquin ai Health District. (Signed) ------------------------------ Contractor) By: --- ------•-• - on ct --- C t or] =�`_ Title �6?-- - (Plot pian, showing size of lot, Ibc oA�os;ysf em in relation to wells, buildings, etc., can be placed on reverse $i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . REVIEWEDBY--------------- ------- -------= . .-.-- - ----------------------- - __ DATE BUILDING PERMIT ISSUED___.._._._. ---------------------• ----- .� - DATE-- --P7-------•-------------- Alterafions and/or recommendations:__."................_- G" - ------------- - -------- - ----------- 1. = - -----=------- --Ga---l-------•---�- ---".----------.----------- - --- - ---- - -- - -- -- --------- --------- FINAL INSPECTION BY:.... •-__ "'c' -� ----------- Date-------- . SAN JOAQUIN LOCAL HEALTH DISTRICT o 130 South American Street 300 West Oak Street 132 Sycamore Street Stook+on, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 116446 ATWOoo 1254