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V��Applicafion APPLICATION FOR SANITATION PERMIT Permit No. 2�.�_�Com lete in Du licate _ _____ ( P P � Date Issued 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-------------- - -----------p-- �--------f _ --------- -- r-------------------- Owner's Name _ _i !Iii -iY--------------------------------------------- Phone �-----•-•------------- Address------------------=---- -- -----------------------------------------------------------------------;--- ' Contractor's Name---------------------------DA- ± / 5 ------5G AIS-f------� ---- Phone..'.57--7?rb�JI' Installation will serve: Residence " Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units:49A15%Number of bedrooms____ Number of bathsZWIS Lot size _,1 �----- __ _--______________ Water Supply: Public system ❑ Community system '❑ Private X Depth to Water Table JS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous'Application Made: Yes ❑ No � New Construction:, Yes E] No 19 TYPE OF INSTALLATION AND SPECIFICATIONS: ©' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ee Septic Tank: Distance from nearest well--- •._---Distance from foundation_-_-f __-----.Material_-__ A(f►41r � mac______________ lZ No. of compartments___ MQ._______Size_jW_-S"&_ 0T6__Liquid depth_-4W-----------Capacity_4? t�_ Disposal Field: Distance from nearest well__v�'_`__._Distance from foundation__ _ __ ........ to nearest lot line___� --------- "e �_. Number o£ lines.__..O�1.___ Len th of each line---- +,:i�______-_-_____Width of trench__ _ __�e �k g et --- -- -------- Type of filter material___!f_� __ b��'L_Depth of filter material__________________Total length-----7.,7---______________________ Seepage Pit: Distance to nearest well___4)---------Distance from foundation---/® '_�- aence to nearest lot line--- � 4al Number of pits___O�O-------Lining material-__46 r_____ _ l91_ � ._Size.- Diamete _____________Depth___00-----------__-__-- I �. l Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__________._________________________. [] Size: Diameter---------------------------------------Depth---------------------------------------------- -----Liquid Capacity----------------------------gals. Privy: - Distance from nearest well _____.______.-------._---------------------------Distance from'nearest building--------------------______ ❑ Distance to nearest lot line-------- --------------------------------------------------------------- ------------------------------------------- ------------------------ i Remodeling and/or repairing (describe)--------------�----- - ' -- ------------at= ------ �'. ' r ------ -----------------------------------------------------------•----------------------- --------- - ------------------ ---- - - -------------------------------------------- ------------- "' `" 'AIL'----- 1 � _s ►' `ot .S ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguP1 , of the San Joaquin Local Health District. (Signed $' ---------- +� i a (Owner a or Contractor By:_--------_----------- ------------- ------------ ------ -------- - -------------{Tiflis)--------� ------ - - • ----------------. {Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------------------------------- DATE---------------------------- �II ------------------------------- REVIEWED BY-------------------------------- DATE BUILDING PERMIT ISSUED---------- ---- - ��Y------------------- -------------------------------- - -------------- DATE Alterations and/or recommendations:_____._________________ _ 1 i -------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------ ---------------------------------------------------------- -•-•--------------------------- ---------------------------- - -------------------------•---•-------•---------------------------•--------- �, 1 FINAL INSPECTION BY:---------_411--V----4 ------------------------ Date------------ " - 0-----` ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stookfort, California Lodi, California !Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100 i