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R APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) *' 1 � Date issued(_n___'�._'S-7 c©1 - /so-Z 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 complian with County 2rdinance No. 549. ��o�_W- JOB ADDRESS Owner's Name--------- ___L.i__� _ --- ------- Phona3hL�► t- 1 - - -- --- ••--- _ ---------------- - ---------------�-- --'�---•--- 2S 4 - Address------------------------s" ----------- �--------•- ---- ------ -----------------------------•------------------------ --- ••--•------------------------- Contractor's Name �k- -••------ ---- Phone--y-h.,--- _?.4 -f�------ Installation will serve: 'Residence ❑ Apartment House ❑ Commercial trailer Court [I Motel ❑ Other E3--- Number of living units: _ _ Number of bedrooms � _ Number of baths .____ -. Lot size __ __r _ �- _r _ Water Supply: Public sYstem ❑ Community system ❑ Private Water Table�_ ft. Cha'a �er 1 of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑I Previous Application Made: Yes ��o ❑ New Construction: Yes ❑ No E❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available otic h:'- Distance from nearest well________________Distance from foundation-------------------Material___________________-___-__-._______..________-... „r..j No. of compartments---------------- --------Size--------•-.--------------------=Liquid depth--------------------------Capacity---------------------- D•sposa�,Fiel& Distance from nearest well_______________ __Distance from foundation_______________--:_Distance to nearest lot line_-__-______. - plumber of lines------------------------------------Length of each line------------------------- :Width of trench----------------------------------- ` Type of filter material-___.---------------------Depth of filter material--------------- ------Total length----------------------------------._____-- _ a p' ~ Distance to nearest well.... _ __Distance fro f_oyndation____ _�____.D'st nce to nearest lot line__ -©-�-- Number of pits__I_ _______________Lining material __ _--Size: Diameter__ _._ �, 1 �'f Depth ---------------- Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material-------------------.____-___________- ❑- =Size.:;_Diaxrmeter_ ,y.. Depth- _ -- ------------ -- - _ . _•Liquid Capacity,,,- -- _ Privy: Distance from nearest well _______-------------------------------------__.._Distance from nearest building------------------ ---__________-______-. ❑ Distance to nearest lot line----------------------------------------•--------------------_____---------- Remodeling and/or repairing (describe):---------------- - -------------------------------------------------••••-------------------•------------------ { 1 ------------------ C I hereby t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfat laws, d rules and regulat ns of the San jJjoaqin Local Health District.[Signed} -- -------- --•----- -- - ------------- ------- ry`s� Contractor] = -- ---- �[Ti+le) f '----- ---------------------- (Plot plan: showing sizeof tot, location of system in relation # buildings, etc.,an be paced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------------------- ------ --------------------------------------- DATE_.�-�------------------------------- ------------------- REVIEWED BY--------------------------------- ---------------------- DATE BUILDING PERMIT ISSUED__.._.._..-----'------------------ - DATE " —_-__ -- Alterations and/or recommendations-------------------------------------------------------------------••--•---------------•-•---------•------•----•-•----------__------------------------------ ---•------------------------------------------------------------------------------•----_----------••-•-------•--------------------------- ------------6-------- .. ---- - - --y-r n _- --- - __w 'x FIN 41NISBECTIO B :.{ �..� Date " 1 R SAN JOAQUI LOCAL HEALTH DISTRIC 130."5o fi m aicareset 300 West Oak Str,at 132 Sycamore Sheaf 814 North "C" Street j Sto e fon, Lfo _- Lodi, California Manteee, California Tracy. California ES--9-2M"Revised W-2100