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i • Permit No. `) APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued `Application is hereby made to the San Joaquin local Health District for a permit to construct and ins 41 the work herein described. This application is made in compliance with County Ordinanc o. 549. - G----�_ --------- ------------ ---------- _ - f JOB ADDRESS AND ----------------------- LOCATION--- Owners Name____ � C ,kr — - ff,� Address-------------------------- L/} Phono_f o_ - � -- y.� I . S-4.1-4_0 Other ❑ -4 1 --------t i Contractor's Name------- �/`� Commercial ❑ Trailer Court ❑ Motel ❑. A artment House ❑ Installation will serve: Resid nce Lid" P �- ----- -----•------- Number of living units: -_�-_._ Number of be __-r- Number of baths _-1_-- Lot size _ Comberio system ❑ Private [] Depth to Water Table Water Supply: Public system Y Y Clay Adob Hardpan ❑ Gravel ❑ Sandy Loam ❑ Cla�ya m ❑ Y ❑ � t"T_ Character of soil to a depth of 3 feet: Sand ❑ NoA/VA: Yes ❑ No Previous Application Made: Yes ❑ No New Construction. Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Ta Distance from nearest well-----------------Distance from foundation-uid depth-_Material------------------------------------------------- I -=_- --_Capacity_.____.___-__-______--- Se ------------------Size------------•-----------.---- G No. of compartments-.__ ` p' sari I��_ Distance from nearest well-_._----:-------Distance f reach line foundation -Width oftfrenchest lot ine----------------- ------- - Number of lines -----------Length o - Total length------------------------------------ Type of filter material------------------------- of filter material----------------------- Distance from founda#ion_.____ -._..___.Distance to nearest lot line`_---•-- Seepage Pit: Distance to nearest weli_t` 0.fte-- Size: Diameter___-' ----- --Depth_-__Z4------------------- Number of pits---- -----------------Lining material_ffv.r -- Distance from nearest well-----------------Diistance from foundation --- --------------Liquid Capacity_ ----------- ------------gals. G Cesspool: Depth ❑ Size: Diameter---------------- - - Distance from nearest well--------------------- ---- ----- �-- -----�- --Distance from nearest building____-.------------------------� ---- -� - ------------ Privy: - ------------------ ❑ Distance to nearest loft ine---------------------- - ------------------------------------------------------------------------------- Remodeling and/or repairing (describe)-------------- -------------------------------------- ----- ----- - --- -- --------------------- be I hereby certify that I have prepared this applicationSand aaqui the cal Heallth District. accordance with San Joaquin County ces, State laws, and rules and reg lations of _ ontractorl ordinances, ;` P it Y ---_ ------- Si ned 1 �- ( 9 ) :----------------------(Title)------, ---------------------- --------I r By:--------------- •--- --------- - ---------- ------------ - ---- [Plot plan, showing size of lot, location of system in re n to wells, bui Ings, etc., can 6e place on reverse side). FOR DEPARTMENT USE ONLY _ DATE-- ACCEPTED BY__� DATE_ ------------•----------- --------------------------- -- ---- ------------------------------------- --------------------------------------------------- REVIEWEDBY------------------------------ --- DATE------- ------------ -- ---------------- BUILDING PERMIT ISSUED------------------------- W------------------------- Alterations and/or recommendations:-------------------------------- -- #-- ----.----- � '�------------------------------------•------------------- P A -- -----------------6' ---------------947—t-1--- ---------------- Dee-----�Z�� - -9-------------------------------- FINAL INSPECTION B SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy. California BO South American Street Manteca, California Stockton, CaliFornia Lodi, California ES-9-2M Revised 1.57 f-P.CQ.