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r. APPLICATION FOR SANITATION PERMIT I� Permit No. ...�..Il_.7..._.. ' (Complefe in Duplicate) 3 - Z Date Issued ..... . gplica+ion 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. S49. JOB ADDRESS AND LOCATION J�/ ,A T� ` �: . - _�_�.r: .`.}. -+ :. j..._�Lo _ �--. �_r. �1�Y..a..._... . _. Owner's Name 1 V- L /t_---_r /).,x..---- ----------- Phone....-- ..,....:. .. ... ... _..._._. ---..... - --------------------- Addressl.l.. -` £ . . `-- --= ..........---'--- `.-------------------- ....-.....--.....------------ -------------- -- ---......... Contractor's Name..............'..-.'.r.;..a.Y`'.......-- -------- --------- ------------------------- .........----------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../_.. Number of bedrooms ..3--- Number of baths .I,-- Lot size .LO..;7..._X.._----o'j__--_---__.- Wafer Supply: Public system ❑ Community system ❑ Private IX Depth to Water Table ._..._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 0 Hardpan ❑ 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.) Septic Tank: Distance from nearest well_c�.O.._...._Distance from foundation-J.D...........Ma erial... No. of compartments-. ----------- a..<':_: ._1--L-.—Liquid depth....-.7.- .._......_Capacity_- -x.02::.11. * ) Disposal Field: Distance from nearest well._.e5. ....Distance from founds}ion_L�d✓....._._...Distance to nearest lot line.._s`'t..____... �_ I [>� Number of lines......._....�.........._...;_Length of each line.- ,A...SF;.ryA_z7_...Width of french----max.-....rT.....:........ Type of filter materialJ'_�:t?�.f.G...l�dp of filter material....J.9_-._......Total length...r ( _._.._.^.. Seepage Pit: Distance to nearest well ......Distance from foundation....................Distance to nearest lot line--------......... ❑ Number of pits.-................_.Lining material-_. Size: Diameter--------------_.......Depth_-------------................ 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 ...................... Remodeling and/or repairing (describe):._... .A.J y.. ...... --.-�-----` .........._..........-`--"........................._..............................................._.-----------_.-...............-------------"----------._ '-----------I—_----"-.-__...... ....__..._......_....._-............................. --- 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 r4kgulations of the San Joaquin Local Health District. r3 ........ --(Owner and/or Contractor) (Signed)----- - �� -�:'.:fs.� '._,.._. ..a.::' -- '-------...., By:-------- -................-..... ......-----------------------................................................... .....(Title)....... - .............. ..... - . ........ ... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE._._ ........._....... - -_ REVIEWED BY-...... -- - - DAT --------- BUILDING PERMIT ISSUED..._................ .. A Alterations and/or recommendations:..__....__ ----_ ......-----------........_------------'--'....... --------------- .................-------••---`_.-------------................................................-..................-----.......................................-..................-................................_- ...........---------I------------'_....................._..................... ...-'-----•.------------------------'----.................................... -40 FINAL INSPECTION BY:..--fit'.... .........................-_..__........... .. Date..... ............_ " --------•-'--------...--...._.....---•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 300 Wast Oak Street 132 Sycamore Stree+ 814 North "C" Sfraef Sfockton, California Lodi, California Man+eca, California Tracy, California ES-9-2M Revised W-2[DO