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'0�— *"� -{� APPLICATION"FOR SANITATION PERMIT K. „� Permit No. :-5p 23 5 (Complete in Duplicate) l - Date Issued -__ 0 - r �t �.Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549. JOB AJillDDRESS AND LOCATION__-__-17-_a._3.___-- Owner's Name---- 4L._ = ---------- ' ---------------------- -------- 4 3t 'Address /7 s /_.e - Ph ill r�-e/ .. _ _ one - Confractor's Name_ Ali : --- Phone:_ y�olo,2 6 ❑ T - Installation will serve: Residence � El Ho se Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: _--- Number ofabedro ms Number of baths _ __"- L t:size -__._-r`Q p_ Q�S4 Water Supply: Publics stem t , w PPY y eCommunify system 0 ---Private-E-•DUpth-1-CPWate Table ``s""ft. Character of soil to a depth of 3 fe mf: and1 ► ❑ Grav e�E] Sandy Loam ❑ Glay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes No i ❑ 1�r New Construction: Yeso ❑ Tl(PE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitfld if�public�sewer is available within 200 feet.)y �I I ., _ . $e tic Tarn Distance from nearest well C� Distancerfrom foundatior5----. __ y t -----.Material__-------G, No. of compartments_.__- - ize---- _ +b --•---Liquid depth------- �- -------C, acit # p Y-------�---- ---- �? Discal Meld: Distance from nearest well-___A_ .,.�__-- _ r i / v i 1W. ..- Distance from foundation,____--.----_.Distance to nearest.lot line-----' Number bf lines_______ :- - --{_ ,-_length of each.line__ I�-�1 - -- T e of filter material'` ; g Width of trench.___ ____1-- yF �_- _--Depth of filter material__-I._-_-I -� _ i 1 Total length----------- ------------- Seepage Distance to nearest wail- �'+�-�---Distance,from. o, rndatio �_ _ '____.Distance to nearest lot line_-a D------- 4e i Number of pits l -----Liningmacial—Size;iameter-- g I• Depth a � = � '. ---- G ss ool: � � P Distance nearest well_ _-""___ ___bistance from foundatio,n_... . i-- .Lining material___ � I ❑ Size: Diameter---____-- ��--_-_- -- s , :, - --- ----•------------ --- F-Depth----,�;:�--- --- -- -: ------ P Liquid Capacity::__. -= 9als. l iv from nearest¢yell # 1 F _DistaEce from nearest building-- r d -----------------------r' --- --- y istance to'nearest,,lotrne } - ' ! _;_- w., --- --- --- --------- ------------- ---------------❑ Distance a ---- ------- g f p q' -- - - ---------- ----------- -------- Remodelin and/or repairing (describe]:_;- r I JI; °" l - _.t...- - .-- --------- ------------------------------------------------ _----------------- _ ___________________________________ ------------ - ----__.__-------------------.--------.--------------------------------- I hereby certify that I have prepared Phis !� pplicatitnrand that the work willfbe-done-:in accordance with San Joaquin County or finances, State laws, and rules andfati _reguons of the San Joaquin Local Hell.WDistri'ct. ii (Signed) ( � -- .. .. ..�._ ! _ ..,l --------------------- u� a` i y.:x,:: *k a - -•--- �(Ow�nernd/or Contractor] - (Title --C -- (Plot plan. showing size of lot, location of system in rel ion to wells, buildings etc can be placed an reverse side). . �I e FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY-------._ ------------- -- - ------- ---- EEVIEWED BY ._ _.._ 5. • DATE (1 = 1 1. ----------- ------- --------- ------------------------------------------ --------- - DATE----- ' A I+LDING PERMIT ISSUED-----= -- ---- ------------------------------- -------- --- ---------------- DATE-------- lt, ratians and/or recommendations------------- 1. 1 E ______________________ - i _____________________________________ _ •_.__...__ z - .___-___._ ____________ _______________________ --------------------------- _____________________ --------------------------------.____._-- l(� ____________________..._____-_______._ --------------------.__-------------------------- -._______ _____________________________ _____________________.__ �, 1 1 i '.--------- a ----- FINAL INSPECTION-BY:-----L.- -_:__ -_ Date_:.. J -� s- ` ' '. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Saufh American Street ..h; 300 Wes+ Oak Street 132 Sycamore Street 814 North C Street Stocfcton, California Lodi, California Manteca, California tTracy, California s ES'4 4-21u1fi Revised W-2100