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' Permit No4. •• -.... APPLICATION FOR SANITATION PERMIT 3 (Complete in Duplicate) Date issued ..__�--.----- Application b n Joaquin Local Health District for a permit to construct and install the work herein described. is hereby made to the Sa This application is made in compliance with County Ordinance No. 549. � � ��_ _ ----------------------- JOB ADDRESS AND LOCATION______ .___ ��------'----y • ---- ----- 1 + t�el-^�.------- --- -------------- ------ - -�----�-� Phone------------------------------------ -------------- ----- ---------------------------- Owner's Name----------------------------------------- --- --------------- ----------- - --- y = �" ` -------�.=------------------ Address------------------------------------- - Phone. �7 `�� Contractor's Name------------------------------- --- ---- ------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms __Y_ Number of baths ----I-- Lot size ------- ~- Water Supply.l • Y sY• Public system jg Community stem ❑n Private C] Depth Depth to Water Table-- ft. l Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe,g- Hardpan C]Character of soil to a depth of 3 feet: Sand F] ` Grave ❑ anY Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)f ��Q_-- ---...Material----- ----------------- Septic Tank: Distance from nearest well._)`� �---Qistance from foundation__. - No. of compartments---- Liquid depth------sa�.2-----------Capacity------- S �C - 93/. dei Disposal Field: Distance from nearest we1l__ftDA2._Distance from foundation_.__ �_r_-__.Distance to nearest lot line _--Length of each line----- '---s- -------Width of trench.-_.o2-y "-/----------------• -� Rl Number of lines___._______._._ _- g Sp+ ��k ------Total Ieng#h---.��?------------------------------ Type ol of filter material-_-�__ ---,..-----Depth of filter material---- ------ .� r r.i I ' { Seepage Pit: Distance to nearest well-.1KOl'•I_E------Distance gfro foundation____1/0--_-_---..Distance to nearest of ine________________ Number of pits-_-!--------------- Lining material_ a'r ` --.Size: Diameter----•- ---.-. ---Deptn..�9 ---------------- Cesspool: Distance from nearest well-----------_-----Distance from foundation----- ._-.--_..Lining material__._______________________________ ' ----De th----------------------------------------------------Liqui.d Capacity--------------------- gals. ❑ Size: Diameter----------------------------- - p Privy: Distance from nearest well___.___-_---------------------------------------Distance from nearest building-----...----.--------.------------------- ❑ Distance to nearest lot line------------------------------------------------------------- --------------- -- - Remodeling and/or repairing (describe):--------- ------ ----------•------ - ---------•---- ------ ---------- r_%------------------------------------------------------------- ---------------------- ----------------------------------------------------------------------------------------------- -- - ------ --- -- done I her ebstete life th t dh ulesprepare reulatsonapplication olf the San Joaquin Local Health will 17eDistr District. accordance with San Joaquin County ordinances, ' _ Contractor) - C-,-/- ------ - ----- (Signed)_ ---- - -------- -----------�-------------- ---- Title ------------- ------------ ------- - ------ - [Plot plan, showing size of lot, location of syste relation to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __- ------------------------------------------------------------------ DATE- - -------- ------�------•------------ ---�-•- REVIEWED BY--------------------- ------ PATE - BUILDING PERMIT ISSUED------------ •• --- -- ---------------------------- ------------------- Itte�r tions and/or commendat'ons:-:-•---_-- ----------------_ - tot -•'� - -------------- •- - ----- 4 -- aa p - - - ---- ---------------------- it -----••------• ------•-- --- :� r ---- T ----------------------------------------------------------------- ---- Datet ---------------------------- FINAL INSPECTION BY:------ -:_----- 1 i SAN JOAQUIN LOCAL HEALTH DISTRICT Y 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac California Sfockton, California Lodi, California Manteca, California Y. ES-9-2M 10-52 Revised W-2100