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i APPLICATION FOR" SANITATION PERMIT Permit No- -- �.`l3�` I/ r (Complete in Duplicate) Date-Issued .-_- --- --- -Sys` L R Applica''ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Herein described.` Y' This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION___ 1- �`l -------___- ------------- -= ----------- JOB ` 1 Name -----------•------------------- ------------------------- Owner's Phon1- ------ -- Address { � -- ' -----------`------------••-•---------------------•-•-----—-----------------`----------------- Contractor's Name--------- --------- �3C�+'�"r'----------- ------------------ -----------------------------------•:------- Phone .�7- —zh-(-!__ �+ - -------- -- ---------- - - Installation will serve: Residence. Ap rtme o sem Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑ Number of living units: A-_ Number of bedrooms _7----- Number of baths - ._ Lot;sizeQl------------------------------- Water Supply: Public system Community system ❑ Private E] Depth to Wafer'Table _ +0 ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoClay'Loam ❑- _Clay E] Adobe Hardpan E]Previous Application M°ade: Yes ❑ No � ;--PNO ew Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r ' (No septic tank or cesspool ermined if public sewer is available within 200 feet.)+ , Septic �k: Distance from nearest well----- -_-_-Distance j�frpm four]dat tion---- _._ C' C ,//9 �1 I'J ` �-------- .Material-------" ------- -------------- Nod of com artments--...--��.._____..-..-Sizer __J�-iDo __11-_Eek --Liquid depth_-�5�2.-r-------------Capacity__j--d0--- L p //yy Disposa ield: Distance from nearest well Distance from foundation-_-.A- '-.•--Distance to nearest lot line-- _-_._ Number of lines---------- -- ------ Length of-each Width of french--- -----------•.---____-- Jr rl fr De th of f'slter material .- -��-_ --_Total length_-'-x= --t �--------- f. Tpe of filter material l ---- -- ------ -- p - . © --------- y i See pa it: P Distance to nearest well___-- -.-_Diance fro fou ation_-=_ :.- Distance to nearest lot line----- ..______ _ --- 6 ti / Tod .. De to S7 Number of pits._ /_____________Lining material-c_e- --._ _ _.Size: Diameter----_ -- I Cesspool: Distance from nearest well-----------------Distance from foundation-_ -.---.__-----_Lining material-_-. -----_-- ` ❑ Size: Diameter---------------------------- DePt --------------------------------------------------Liquid Capacity---------------------- ----gals. Art Privy-' Distance from -nearest well._.-___-_._-----_-.'___ _- --------------Distance from nearest building--__---______-.---------. .------_-_._. �, _.�-..� _ Distanceto nearest lot line-.....................--------------- --------- ----------------•---------...-.-------------------------------------------------- ------------- Remodeling and/or repairing (describe)=------------------- ------------------ ---------•---------•-------------------------..---------- = -----•----------------•---- -------------- . . ------------•-•---•----•----------•----------------------------------------------•------------;:------------------------------=--------- ---------------; ------- --------- -----••---------•------------------------------- ' ---- N ---------------------------------------------------------------•-----------------•----------------------------------------•---------•--------•---------------------------•----•-----------------------------------. 44 I hereby certify that I have prepared this application and that the work will be done'in.accordance with San Joaquin County f• ordinances, State law�aules and reguiatians of the San Joaquin Local Health District'. Y Can )----;i`4 (Signe ------------------- ----------------------------------- _ . and/ortrt; • ----- -- -- ----------- --- ---------- ------- ---- ---- (Title)-- By: -- '----------------------- i ------------------ (Plot plan, showing sizerof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- '------------------- ------------------------ DATE------- Is_-.---.- . ------ =--------- REVIEWED BY------------------------ --------------------------------- DATE--------------------------------- ------------------------- =' BUILDINGPERMIT ISSUED---------------------------- -------------------------------------------- ---- DATE.----------------------------------------------------------- Alterations and/or.recommendations:---------------------------------------- ---------------------------------------------- ' --------•--------------- -- -•---...... -------------------- ----------------------------------- •--- Y E _ z - ------ ------------------- --- __C 0-2- _-- �----- ----------------------------------------------------- FINAL INSPECTION BY--" "----- --- --- ------- ---------------- Date yam/ f f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814-North "C" Streef Stockton, California Lodi, California Manteca, California t `�'fraay, California , ES-9-2M ; Revised W-2100