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APPLICATION FOR SANITATION PERMIT Permit No. ...... • ..- (Complete in Duplicate) V- r•r'' Date issued 6/ �3 3 Applicatio Thin is a by made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549_ JOB ADDRESS.A, jp LOCATiON... ..- 2. i -- --------------------------•----••-------•---------------• -------- -------- Owner's Name--------------------�-- •- ---- — Address.._..._.�� Contractor's Name--- •------•-- - •-• -----•-----------_••--------------------------------------- ............................. ............... ............... Phone-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Number of living units: :-� °�}e-lI❑ Other ❑ Number of bedrooms -Z- Number aths "_"�__ Lot size .___�© X e� � Water Supply: Publics stem Q----------- - Y Community system-❑ Private, Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ ClayLoam Previous Application Made: Yes i No E] Clay L] Adobe[I Hardpan [] ❑ ! ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) i Sep 'c•Tank: Distance from nearest well.. ............... from foundation____"_-._____ No. of compartments----------- ------ - Size -""=....._.__.. --.Material................................................ vV D's o al i d: Distance from nearest 11- � Liqu'd dept Capacity , 19 --"._.Distance from foundatio _.__....-. � p'- umber of lines__ Distance to nearest lot Length of each fine------- �r�''•.•._.._. ype of filter maters rt•--•Width of trench___ -_2i ! �� epth of filter material__.-___,�__ --_--_" { "'------ See a ! -Total length_._.__.-.-I,a� Seepage � . Distance to nearest well_.......""_.__....____Distance from foundation.........__________.Distance to nearest lot line__._.-._____" .__ ❑ Number of pits..._---_-- ••-•__ Lining mate*ial............. Size: Diameter ------------- Depth----- ................. Cesspool: Distance from nearest well...._______"_ Distance from foundation-"""___._•-_- Lining material_. ------"-- ❑ Size: Diameter__...s......................_-_-___-Depth............................. -•-" "-- - ------- -----------Liquid Capacity.-. ....... ......... Privy: Distance from nearest well.................. ............... -----gals. Distance from nearest building.__"--.__.__".__•• ❑ Distance to nearest lot line.____.._""_.- -_•- ..............."__. Remodeling and/or repairing {describe):__ -_"__. -------- • E 1 ---••--• ------___"------------ -------------------------- ----------------------------------- -------.............. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy (Signed)_-:n M• /•< 'Octet'(' ` = ----•......................".__._-"- -•-•--..."--•-•....___.....------.(Owner and/or Contractor) By:.............................................. {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., cant be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY--------------------•-------•- DATE-�-�-- BUILDING PERMIT ISSUED •----•---- ---- DATE__.. ----_.__.. 7 ' Alterations and/or recom endations:....__ DATE _\] ..... ._ s� ---------- ••-- - El�! d_ l il kl.C.__..._--•- -----4,-.,x11...... n FINAL INSPECTION BY:... f �—�4sf---Irfafl, s tr California a Q y �S�eel 6!4 North "C" Streat Lodi, Cali rnia tse • Yr Calif o ie ES-9-2M io-52 Revised W-2100