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ArrLICATION FOR SANITATION PlEkvwiT. Permit No. ...... <br /> (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th wo k herein described. <br /> This application is made in compliance with County Ordinance No. 549. 0 11111 <br /> JOB ADDRESS AND LOCATION... <br /> ...........W------------------------------------------------------- <br /> Owner's Name...... -------- ....le, ................................. ............................................ Phone------------------------------------ <br /> Address....... ------------ . ............. <br /> ............................................................... ............................. <br /> Contractor's Name------ . ..... . ... ............................................................. <br /> Installation will same: Residence RL Apartment House [] Commercial [] Trailer Court ❑ Motel [] Other ❑ <br /> Number of living units: .40 Number of bedrooms ........ Number of baths -.--Lot size ...40.10" --- - -- ---- <br /> Wafer Supply: Public system E] Community system 0 Private [] Depth,to Water Table '40t. <br /> Character of soil to a depth of 3 feet.- Sand 0 Gravel [] Sandy Loam F] Clay Loam 0 Clay [] Adobe BL_Hardpan ❑ <br /> Previous Application Made: Yes E] No [] Now Construction: Yes Id-No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted of public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well. _;70--- Distance from found alion....411.6.........Material---- ............ <br /> No. of compartments........ ..... iquid clepth_ ity <br /> A -0..........Capac -_ I <br /> Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line...------------- <br /> El Number of lines...................................Length of each line--------------- - --- ........Width of trench.._...............__._......... <br /> Type of filter material......................._Depth of filter material------ ......... ......Total length.......................................... <br /> Seepage Pit: Distance to nearest well-- /-.Distance f om undation .C.,Ir.......Distance P nearest lot <br /> Number of pits..._ Z---------Lining maferiaI.:AZiP ..,A_jjN*016ia meter------ Depth...,52,:5;.. ........... <br /> Cesspool: Distance from nearest well.................Distance from foundation........_....._. Lining material......__- ......................... <br /> ❑ Size: Diameter..................... ................Depth........................ ................. .........Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well..._._._...._...............................Distance from nearest building............. ...................... <br /> 0 Distance to nearest lot line.__.._._........_............._......- ........................... .................................................... <br /> Remodelingand/or repairing (describe):.................. ...................................... .................................................................................... <br /> ......................................................................................................................................................................... ...........------------------------------------ <br /> ................. ...... ...................I.............­.....___.....................................I...-----................................. ............... -------- ........................ <br /> ..............­_...............................................................................................................................................................................................6-ois,�y <br /> I hereby certify, I have prepared this application and that the work will be done in accordance with San Joaquin <br /> ordinances. Kfa!! "wmlncl rules and regulations of the San Joaquin Local Health District. <br /> ..................................... ----------- -------(Owner and/or Contractor) <br /> By: -------------- --------- -----(rifle - fn...... _----- .. ................ <br /> (Plot plan, owing iz�_ai lat. location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 19 size 0 lot. location FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_........... -----------.-. DATE_....-.-..-..._ <br /> REVIEWED BY............................. ----------- ................. DATE.....------'• <br /> 11 ------- -------------------------- ----- <br /> BUILDINGPERMIT ISSUED.--------....... I ..... .................................................. DATE................. ..........­----------_------- <br /> .............................................................................. <br /> Afterations and/or recommendaflons: ::"::::::::.. ....................... ... . <br /> .:�...... ... ........... ..... C <br /> ................ ..­.... ... ... . ..... S ......1.��.......... -------- ......A .......................... <br /> ...............­­.................................................................... . ............ -----------•----..... ................................ <br /> ................ --------------------------- ---------- -- <br /> We..... _ .... ........ /_3----------- <br /> ............ ...... .. . ....�� . ..L <br /> - ------------------------ <br /> .................................................... ............... ................................ ......................................................... ................................... <br /> FINAL INSPECTION ................................... Date ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amer;". Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> St.c1for, California Lodi, California Maniacs, California Tracy, California <br />