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'7'/-7:t APPLICATION FOR SANITATION PERMIT Permit T -6, {Complete in Duplicate} Date issued ,! =--�— ai Health District for a permit to consfruct and install the work herein described. Application is hereby made to the San Joaquin Loc This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION____________ ` Phone------------ ----------- ---------- I?------------- Owner's Name--------------•-----------.---- _ - •----------------------------------------------------- Address ---------------- -------- ------------------ Address---------------- ------ Contractor's Name------------------------------ E ---- Installation will serve: Residence Apartment House El Commercial E] Trailer Court ❑ Motel E] Other E] Number of living units: I---- Number of bedrooms --_ Number of baths ________ Lot size . { Water Supply: Public system, Community system ❑ Private ❑ Depth to Water Table Clay ❑ ❑ Gla Loam Adob Hardpan [ICharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Previous Application Made: Yes ❑ No 59', New Construction: Yes;F�,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) 4 Septi Tank: Distance from nearest well � _ .___Dist� rom rf�un a$"or_ :� Material-- ------------------------ -- ------- Distance _ k No. of compartments_"--______-- Siz ___-- ------ ----Liquid th__,$'- "--------------Capauty--_-- ✓✓`al _Distance to nearest lot line." r Disposal Field: Distance from nearest well___ Distance from fours ati 1r Number of lines_.________ Length of each line__ 0- "-------------Width of trench____------------- ---- r ----------- r • "_De th of filter material_ Total ler.gth�._L2------------------------------ Type of filter "�S p See e Pit: Distance to nearest elf___._ P£Yl+''!----Distance TrAm foundation--- _ _____-.Distance to nearest lot line__,.'`.____. �" _..Size: Diameter_- ----- Number of pits-----/__._ ------Lining material- - Depth._ . ------------------- Cesspool: Distance from nearest well_______._______Distance from foundation------------------- material______________________________________ -Liquid Capacity gals. ❑ Size: Diameter------- ------------------------------Depth----------------------------------------- ____ Privy: Distance from nearest well------------------------------------------------- from nearest building________________------------------------ ❑ Distance to nearest lot line------------------------- -- --------- ---------------------- - -------------------- ---------=---- Remodeling and/or repairing (describe :_______----------------------- ------------------ --------------------- ----------------------------------------•---------------------- I hereby certify that I have pr ed this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, rules and re ulations o +he San J Local Health District. Contractor} f -1 _( .-i -- -- 0 S _A"�-C------------------- (Signed) -4- ---•------ - --- - By ..--------- --- - - - ------(Title} _1_. f/� ��.. (Plot plan, showi ize of to+, location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR D RTME T USE NLY APPLICATION ACCEPTED BY______ D ------ - �------- -- -- --- - -- DATE---- ---------- -- ------------------------------•--------- REVIEWED BY--------------------------------- ------------------------------------------------------------------------------------- --- BUILDING PERMIT ISSUED----••---------------------- ------------- --------- --------- -------------------------------------- DATE----------------------------------- ------------------------- Alterations and/or recommendationst__________________________" ---------- -------- ----------------------------------------------------------•------------ r 1 i FINAL INSPECTION BY:------------.----- .- ---- f ---- ------- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reel 300 West Oak Street 132 Sycarnore Street 814 North "C" Street Manteca, California Tracy, California Stockton, California Lodi, California c 1 ES-9--2M 8-51 Revised W-2100