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APPLICATION FOR SANITATION PERMIT Permit No. .. .`.?...�.�-? (Complete in Duplicate) 3 \ Oy� ;Z Date Issued ..... s ...�, Ap lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h i de escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.._..f.44----CORN_E20. /_��✓ :'#-- -t'./YdL'17---11cI------------ Owner's Name----------------------------------- 2.+e. ,� .d.f ..11 ---------------------- -Phone: a'wJ_ , .3 ----- Address.............................................. -------- -- ----------------------------------------------------------------------- Contractor's Name -•---------------------- --------------------...-------•------------------------- -•-•• Phone--- ,`� GO. .. Installation will serve: Residence ❑ Apartment House �``//Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms .-:"ir_ Number of baths J_-. Lot size .... C4-. 4-t------------------------------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table .4.0 ft. P141--. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No Q�, New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic_Ta k: • Distance from nearest well.................Distance from foundation_-------.-_-_-----.Material------------------------------------------------- - Flo No. of compartments_-----------------------Size-------------------------------Liquid depth----------------- -------Capacity----------------------- Di osal end: Distance from nearest well-.---------------Distance from foundation-...................Distance to nearest lot line................. Number of lines-----------------------------------Length of each line------------------------------Width of trench-----------------------:............ "'CCC V Type of filter material.......... ............Depth of filter material_--...__-___------._...Total length.......................................... Iles -- e See a e Pit: Distance to nearest well-10D-- ------.Distance from foundation- S-..-......Distance to nearest lot lin ..�.�► �. Number of pits....�----------------Lining material.�� C�-..Size: Diameter_...�-�_y.-----.-Deptn--4 !....�R" _.__.. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.-_._.--___--------_--.--.-.-__. ❑ Size: Diameter--------------------------------------Depth------••--------------------------------------------Liquid Capacity..------------------..------gall . Privy: Distance from nearest well------------.------------------------------------Distance from nearest building._----__..---------_..___.-------..._--- ❑ Distance to nearest lot line----------------------- --•--•--_---........................... --------------------------------------------------------------------- Re m , el im -----•-------------------------------------------Rem : ell d/or repairin scribe)a --------------------------- 51 ----- $ Y ---------------------------------------------- -------------------- - ----------------------------------------------------- ------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------•-----------------------------------------------------------•------------------------------------------------------------------ 1 herebPa tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, rule nd regulation of a San Joaquin Loc Health District. (Signed) C------ -- - ------------------------------------------------ or Contractor 2,4 By:--------------------------------------------------- -- -i -------- / ------------• ------------------(Title).. _Aj �_�Y1- .-1_0_R--------------- (Plot plan, showing size of lot, locatio of system in o wells, bui rags, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�,,:7---------------------------------------- ------ ---------------------------------------- DATE .----- --- ----- -------------------------- REVIEWEDBY--------------------------------- /'�.-�-------------------------------------------------------------------------------- DATE....�.3�;... BUILDING PERMIT ISSUED---------_---- --------------------------------------------------------------------------------- DATE-------AA---------------------------------------------- Alterations and/or recommendations---------- ------------------------------------------------------------------------------------------------V----------------•------------------------------- ------------------------------------------------•--•------------------ -----------------------------------------------------------------------------------•----------------------------------------------------------- - --•-•----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- --------•---------------------------...---------------------------------------------------------- ----------------------------- -------------------------------_---- Ll.-'.. ------- - `f FINAL INSPECTION BY:---------------- _ .... --- Date......-._--_..,�� .,�.5 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street StockMn, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100