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d' 6 (� PLI R SANITATION PERMIT Permit No. ` mp f in Duplicate}- Date Issued Applicpaption isFhe�y m e to a San Joaquin Local Health b rict for a permit to construct and install the work herein described. This application is ade in compliance with County rdinance No. 549. JOB ADDRESS L CATI N- -05z O Owner's Name________ ----- -- -----•-•----------------------------------------------•----------•--- -- ----------------------- -- ------- . -- --------------------------------------------- ------- ---------- Phone-Q---V-14- 1------ Address-----•------- 3. 1 � Contractor's Name,-- -___ . -- - -------------------------- __ Phone Ins+allation will serve: Residence Apartment House E] Commercial ❑ Trailer Court • ❑ Motel F-1OtherNumber of living units: ------ - umber of bedrooms --Z_ Number of baths ___ ____ Lot size Water Supply: Public system Community system❑- Private ❑ Depth to Water Table _--- _ ft. r Character of soil to a depth of 3 feet Sand ❑ Gravel [:] Sandy Loam Clay Loam ❑ Cl!y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Q/ New Construction: Yes Y No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool permitted if pu��b}}ly sewer; is available within 200 fee+.r I Septic Tank: Distance from nea�resr w0c5o____..__Qista cp from Ifo a ' 1 ateri I No. of com artmenfs_ ------- -- ---- -- - p , 'Si e x�Q' -- iquid fepi4i -- �} Capacity '�---- --- ------ p Field: Distance from nearest e! �._____- -. ist'ance from foundation�_f1- !Distance to nearest lot lin _____ -_- + �f� --•---- Number of lines--_.1--- --------- ength of each line--_----- ---- Width of trench-------t� - y Type or filter mater �V �'} ---------- = epth of filter material__ .__1. _______-_-Total } length--- / 4-- ------ Seepage Pit: Distance to nearest"well-_'____________________Distance-fr—m foundation_"___.-"-_':_"`_.Distance to nearest )of line____.__._._____ ❑ Number of pits----------------------Lining material-------� ------------Size: Diameter------------------------Depth Cesspool: Distance from nearest well_________________Distance-From foundation__.________._-.__..Lining material._._____-_______.__..__._ _ * ❑ $ize: Diameter ------------------------= -` Depth---- Liquid Capacity Privy: Distance from nearest well------- _-----:- ----� ------------------------ga -_____Distance from nearest building________________________ ❑ Distance to nearest lot line----- --------- 'w.,--*..� ` Remodeling and/or repairing (describe)_______________.___._.___.___ - i --------------------------•---------•- ------------ 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 regulations of the San Joaquin Local Health District. (Signed)• «. �� i--- - --------------- -�- ---------------------------------------- •--- --------- (Owner and/or Contractor) It By:., ---------------------------------(T* --------------------------------------------- (Plot plan, showirt size of lot, Iocaiion of s �rninYto wells, buildings, etc., can be placed on reverse side). g Yra t ---------------------- 'FOR DEPARTME •'T USE ONLY APPLICATION ACCEPTED BY ______ d REVIEWED 13Y.____-- ------------------------------=---------------------------------- DATE_ ------------------------------------------------------------------ DATE BUILDING PERMIT 1SSUED--------------------------•---------- - •-----------. DATE------- ---------------- -- ---------------------- --------------------------- I A aerations and/or recommendations: ti --- - --- ------- -------•---------•----- 7Sk w ----/ -- - --------- - ---- -(-r:/.)- -- -- ----- sift �.a � -� � � .J � lr2--- --- - r - -------- -- FINAL INSPECTION BY:.----- -- _-? Date_ /-p- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockfon, California Lodi, California Manteca, California + Treey, California ES-9--2M I0-52 Revised W-2100