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APPLICATION FOR SANITATION PERMIT 6 Permit No. ... (Complete in Duplicate) 1 . Date Issued -.-_C^`-_.7. / IJ Applica+ion is hereby made to the San Joaquin Local Health District for a permit +b cons ct end ruinstall the work herein describe . This application (s_made�in_complian a with County Ordinance No. 549. p' '"E770 a O:R •2 0•. -------- - ..... \ JOB ADDRESS A CATIO cl v!f�P/•-. .QO :..LY'. (� � '' U _....-V.----.---................:.... Phone..- 6 -----......... .'06 =Ovr�iet s�Neme------- ------- -----...._..A .... ......--- ._..r..-'..................--- ' �y / 27- 0-- Address...... O v p �� ----------------------------------- _7 - _ .. uj Contractor's Name- Phone-- --.-. '. Installation will serve: Residencet Apartment House O Commercial ❑ Trailerr Court ❑ Motel ❑ Other ❑ .G;�i" P ------•-- Number of living units: -..L. Number of bedrooms ._VV. Number baths -...... Lot size _-., , Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table -- ----- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub.l,i_c,sewer is available within I feed.} Septic ank: Distance from nearest wel- �Q f [J 7!! :.'Dista ca fr m`f da .......:......._...Mato i L. — 9 o'f`xl �.KG� Liquid .Ie •h W-- Capacity.... No. of compartments-----... ...I-------Size-`---- -r - -' r' pfi '.J--- -------_.. .e�•/YiH'>r IS>C! istance from foundation . .....��.. Distance t, nearest lot+lir e................. Dispose,Field: Distance from nearest coal nr 1 ff Number of lines............ y_-_Length of each line......... � rff-_Width of trench..... T_.....__........ ' Type of filter materiaP.F3• f.P..:�" p �' - ff ......De Depth of filter material........ 9........Total length.-..____ .0... .....--- 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. S Privy: Distance from nearest well................._... .............. ......Distance from nearest building...------------------------------------- . ., ❑ Distance to nearest lot line-------.,---- ............._....... ----------...----------•--------------- -- i Ramcd ling and/.or repairing deserib ;.e................_ -- -- ".. �_ / ! ��•r�- --' A eflth!J!1 !!ktn'P � - !^ /.!.. H+y),-� - .............. '' - .._... - ' -----'................................----............ ......--.....----------------------------------------------------------------` ------------------ ........--'--'............. ..----- I hereby certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned �}!� --------- IV ........................(Owner and/or Contractor) - -'- .......................................................... ........-:(Title).............._..--------------------- - - - i 8y..-----• -..........----- V (Plot plan, showing size of lot, locetioe'of systern in-relation to-wells; buildings,.eto., can be placed on reverse side) FOR DEPARTMENT USE ONLY -' APPLICATION ACCEPTED BYC ... .. DATE li....................................------------- L DATE..6; ----------.................................. REVIEWED BY-- ------- --- - - - ..,........ - ---- - - .+' BUILDING PERMIT ISSUED-------------------•--------- '-=----'------- --- '-- -- -----------......_... '---- . DATE........ -'- - - -- Alterations and/or recommendations:...--". ......... .......... ..........................,_..�----- -----`--................---- - -•- ..--- _.... - .._...—' .. ------ --------------------------------------------- ------ _.------------- ----- - .- _ . _ - - s - --................................. --- - -- ....................................................................... FINALINSPECTION BY:--------------- ---- -- ............. --- --- - - Date -- - --------------------------- ....-----....----------------_--- SAN .-----•---SAN JOAQUIN LOCAL HEALTH DISTRICT 137 Sycamore Street 814 North "C" S+raat 130 South American Sfraef 300 West Oak Sfreat Mentees, Callfornie Tracy. California E Stecklon, California Lodi, Californiania i rc�_g ,v-.a.b niwOUO �1