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APPLICATION FOR SANITATION PERMIT Permit No. ._1...4�..l .l.� t (Complete in Duplicate) Date Issued ...J•- � Application 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. 2-S'O-14'O-U J ?�Z W. E S/ ' JOB ADDRESS AND LOCATION.............�Z?Z1z....,.. ...- _lf.._._..-.... _..... .. ... !_. .....---. Owner's Nam � �............. Phone......._..... ._ ..._.- .... Address.-..,- -�f...... - - u1z� - - _ :.. � jj� Contractor's Name....... f.:. ....= --...... ----........_..__....'--... ---------' Phone....-- '------...._ Installation will serve: Resi ence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑_ Other ❑ Number of living units: I.. Number of bedrooms !2A... Number of baths ...I. Lot size -._...: _ _.._.:.._.f..� +�i" Vater Supply: Public system ❑ Community system ❑ Private P Depth to Water Table .I__ ft. U Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay { Adobe❑ Hardpan Previous Application Made: Yes ❑ No K New Construction: Yes ❑�Nto �.FHA/VA:Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (/ Septi e;k; No a cesspool permitted if public sewer is available within 200 feet.) (Nc tan r r ce from nearest well....�_.Distance from foundation..._-.......Material-.........._..._................__.......... compartments..---.._- / �, Size-----..--.----...__._......._Liquid depth_..--.-_...__.._....-_Capacity...-....__...... ._. Disposal Field: 1 i t ce from near st well....14?._Distance from foundation _.. a _,.Distance to nearest lot ,❑/ r of lines...7-.... Length of each line. I�r.-.P`� ry ...Width of trench.. z• '��...... ......... x of filter material,-:252.4- _..Depth of filter material Z .........Total length......_ c �.-._. See pag i Distance to nearest well..----..--.........-Distance from foundation.....__,.......__Distance to nearest lot line................. umber of pits.................._.Lining material......_....._.-_.....Size: Diameter._-__.--_-....._...Dept h......_..._....»-............. CeW$spoo:/ Distance from nearest well...............-Distance from foundation....................Lining material..............................._... ❑ _ Size: Dia meter._.._._-.-_....................Depth.............-_.---..--.•..................._.Liquid Capacity.._................__.._gals. Privy: Distance from nearest well.................................... g................_,_,.,..-..... -._........Distance from nearest building -._.-_... ❑ Distance to nearest lot line.......---...........................-................. .......................-•----...... - ,_..-----------__ ReWdefing and/or r rin I escribe): Q3v4ti ----. ..- Q✓- t��4�L� cs -. .-._..................... ..-. .._G%t .. .. �d�. ... __..-_.......... I here certify that 1 have prepared this appli0ion and that the k will be done in accordance with San Joaquin County ordinances, taje-law;, and rules and regulations of the San Joaquin Local Health Disfrict. (SEgned)_. .. .- -' ..... (Owner^ - .................... ----.__....__----'-...._.........._._..-. and/or Contractor By:.-•-••-- - -- -- -•---_....................................................................................(Title)........... ---- ..-..-------.-.------------ (Plot plan, showing sae of lot, location of system in reletion to wells, buildings, etc., can.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ....... ................. - ..........- -- - _.-_. DATE. .... ... .-.._...... ,^ REVIEWED BY............_......................_..__......_..._._------.... .... DATE..... i-�. -- BUILDING PERMIT ISSUED_......................................._...,.. .-_ DATE-....,Y-.-_........._...._.._.------__-- - Alterationend/or recommendations:................. ---.........__....._....--..._._._._.......:.._....--'---.._.----`--•----....»-_.-----'-`----..._...-- . . ..._...»...-............................... ............................................................----"-'-_...-..........,.....»...._..._.....»..................................... .._...... ...•--•---.-__............._.`--__......................._.....-- -' ----..,.............. ----._-.------------- _-------------- ...----- ------------- ..._............... FINALINSPECTION BY:......................-- .......................-......_.:... Date............... _............._....--W_ ............... SAN ....._....-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sheet 814 North "C"Street Stockfam "Ifornia Lodi, Celifomis Manteca, Califorala Tracy, California