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APPLICATION FOR SANITATION PERMIT Permit No. ...Fr .-L_____ (Complete in Duplicate) 91/� Date Issued ___________________ Applica+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. 549, l JOB ADDRESS AND LOCATION _ L�Ir1 __ T :_I e:RE - XLH:..--0-----{-----//i------rc /4------ x_----`----- u��7 Owner's Name. 1 L Q tZ. e l�------ ------------------------------------------------------------- •------------------- Phone---------------------___----•---••-- Address------- 7 5 T° � = ------------------------------------------- - -• - - Contractor's Name--•---V 19-A- rX&_.....••-•--,G hf `------------------------- --------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Q/Apartment House ❑ Commercial ❑ Trailer Court ❑ -Motel ❑ Other ❑ Number of living units: ___/--- Number of bedrooms _-_"7 Number of baths ___A. Lot size -___ Water Supply: Public system ❑ Community. system ❑ Private Depth to Water Table S-0 ft. - i 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 �iVo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well_____"�Distance from founda�jon-__-_/ .� Material-_-_eC_�!�------'�__---------- V. No. of compartments......7- .d-------Size----- ____ __-f-C----Liquid depth__.__-G: ' ---------Capacity___ "Zo- Disposa Field: Distance from nearest well----Ka---`-Distance from foundation____ 0 Distance to nearest lot line____---___---__ Number of --------Length of each line__ ___ ______________.____._ idth of trench----"_�Y- .__________-_ Type of filter material__"_1 _ �`! ----Depth of filter material.-_."" _g �r Total length......... ___ �d--� ` /I-;--- - Seepage Pit: Distance to nearest well_.,-ft---------Distance from foundation__1_Q----------Dis anj to nearest to line!___sS-__-____-- ��17f` Number of pits- Lining material_ -__ "___. ___Size: Diameter-.-�. �• �j �- ---- -----Dept h-----� -----------------• I Cesspool: Distance from nearest well_________________ Distance from foundation.--.-_------ -.Lining material-------------------------------------- 0 Size: Diameter---- --------------------- - --------Depth--------- -------------------------------------------_Liquid Capacity----------------------------gals. T ' Privy: Distance from nearest well--"--- ---- ----- --------------------- --------Distance from nearest building---------------------------------_______ ❑ Distance to nearest lot line---- ------------------- --=-------------------------- Rtelin and/or re airing [des _ - -- ----- ------� �-.---- ----- 1s =. -_ _ f c -r fr----�'------- J_.._ - :��.,., -------------------------------------------------•------------------------------------ ----------------------•U---------------------------- -----------------------------------------------------------------------------------------•-"----------------------------------••-- ------------------------ I hereby certify that I have epared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. r� 1 s /�C - (Signed).............. .. .--------------------- - ------------------------- --------- ---------------;---------------------------- ---------- -- ----(O n r and/or Contractor) gY• -------------------------------------------------(Title)-- (Piot plan, showing size of of, 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---------------------------------------------------------- DATE- ----------"-. --- � BUILDING PERMIT ISSUED----------------------------------- --=-=--- •------•-•- --• ------------- DATE- ------------------------------------ Alterations ATE Alterations and/or recommendations----------- ------- � i - ------------- ------------------------------- � -Y ( `J -----•------- ----- ------------- —-��-`• 0 FINAL INSPECTION BY:._ v- S Date__. r .. - SAN JOAQUIN LOCAL HEALTH DISTRICT / 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street f Stackton, California Lodi, California Manteca, California Tracy, California ES—g 145446 arwnoo ;