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APPLICATION FOR SANITATION PERMIT �. Permit No. . __ '11�-3___ i (Complete in Duplicate) Date Issued _W__ZF Application 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. �p JOB ADDRESS AND LOCATION r}r�a_--Ct_. L ' �' � Owner's Name ,= - Phone d Address---------- ------------- �----- , Contractor's Name -------------------- '' ��,----Q -__-Yu'_- .. ----------------------- Phone...... � f-1 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherxA,44w - aSzNumber of living units: Number of bedrooms _�_-_ Number of baths ------ Lot size ---- ----�L'..AP�------------------ ------------ Water Supply: Public system ❑ Community system '❑ Private 5d Depth to Wafer Table ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loani ❑ Clay Loam ❑ Clay ❑ Adobe 1' Hardpan ❑ Previous Application Made: Yes ❑ No R, New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest oswelL�b�----Distancefrom oundafion---� . ----.Material--r -- ---- ---- No- of compartments- tanc-A_ - X Lquid depth__.��r/�-----------Capacity------_y Disposal Field: Distance from nearest well-6or--..._ - I Distance frfoundation-7,--41m _ -_____.Distance to nearest lot r.. Number of lines------r-----_--1l-�-------------------Length of each line------�-0-_------------Width of trench �_ri�''______-_-_------- f� Type of filter material_-l_/_�`1l ____Depth of filter material______19........Total length__ Q. --------------------------- Seepage ___________________ ___ Seepage Pit: Distance to nearest well.-I_0®'-------Distance from foundation... 1st nce to nearest lot line.... _ -- Number of pits------- ----- ----Lining materialalr— � ;__Size: Diameter___�--------------Depth__ _ ____-------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______._-_--------------------------- . ❑ Size: Diameter---------------------------•---------Depth--------------------------------------- -----:------Liquid Capacity--------------••------------gals. Privy: Distance from nearest well-------------------------------------------------,Distance from nearest building------------------------------------------ F-1 ______-_-__________-_________-_-_---__.❑ Distance to nearest lot line----------- Remodeling and/or repairing (de scribe):_ ----------------- ----------------------------------------------------------------•---------------------------------------------------------- -------•-------•-----------------------------•-------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San jJoquin Local Health District. 1 ' Werl�j (Signed)--- � ---- -�, -- �- - ----; Contractor) - --------------- -- --- - By:------ - ------ ------------ ----------------------(Title)---� - -� ------ - (Plot plan, showi g size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY_________ s ----- - _ ------- DATE------ ------- REVIEWED -� •- �Q BY-------------------------------------------- ------------------------------------------------------------------------------ DATE- - ---------------------- BUILDING PERMITISSUED-------------------------------------------------------------,---------------------------------------- DATE - - --------------------- Alterations and/or recommendations----------------------------------------------- ---- -------------------------------- ------------------------------------------------------------- ---- --------------------------- FINAL INSPECTION BY:-------------- Date---- ---'-y--- -- /14 ---_--_ �/� ----------------------------------- SAN ----------------- -------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Sfreet Sfockton, California Lodi, California Manteca, California Tracy, California s ES---9-2M 5-51 Revised W-2100