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,\\ � APPLICATION FOR SANITATION PERMIT Permit Nlee o. ___.!___! •""------•- �. (Complete in Duplicated Datea " 1G" -- I� ?"'AA'pplica4ion iis 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. JOB ADDRESS AND LOCATION--_._ - "" --- __4---------------- -- -- ------------------------------------ Phone.---- -------••-----•--------••---- -- Owners Name „ ----- ---------- -- Address - ------------- ------ --•---- Pho Contractor's Name------- - - -----------_. - � Ftment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence .. ❑ -. �- :. I X---- 2- -------- Number of living units- __t___ Number of bedrooms Number of baths .l_-__ Lot size ____ __.-.___ _ . Water.Su I Public system �¢mmunity system ❑ Private ❑ Depth to Water Table 1p_ ft. PP Y� Character of soil to a depth of 3 feet: Sand ❑ Gravel 171 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan C] Previous Application Made: Yes Z- d E1 New Construction: Yes l "'�' 1--� TYPE OF INSTALLATION-;AND SPECIFICATIONS: - (No septic tank or c�sspool permitted if public sewer is available within 200 feet.) ` S pti Tan1 - Distance from nearest well................"Distance from foundation ----- d-- th-Material-_-------_Capacity----------------------- No. _"__. ___.________.. No. of;'compartments---------------- - Size q l? E 4(J t lot Dispo al Field: Distance from nearest wel�."Distance from foundation_"_. -/_.! Wthcofttrenche5,�.u_ 'line Number of lines------- ...- Length of each line_"_-_-k ------------Width `t< - Total length ------------- Type o� filter materia}___(_ �i--------____Depth of filter material_._..'.-------.- 9 �. Seepage Pit: Distance to nearest well._________________---Distance fr'o foundation Distance to nearest lot line__._______-.- Size: Diameter Depth _ .,.. Number of pits.--- - --- - Lining material----------- - -.�--�,,.:..� —! ---- ;;,,,,� � esspool:�,...��-Dist�anca=fi�amrnearest-well.:••='"�"Distanee�fram foundatio`n________ __ ___ -Lining material ----- ----- ❑ Size: Diameter---- -------- ----------------------Depth-..----------- �--'--------- ---------•-----------Liquid Capacity----------------•-----------gals- '' f;-------------- from nearest building------------------------------------------ Privy: Distance from nearest well--------------------------- - - ` ❑ Distance to nearest lot line------ ----------- --------•----- ----------------------------•--------------------------------------- li -------------•----------•-- Remodeling and/or repatnng (describe):-- ------- k ___-___"..._ .�sT�".__.""".._""-"• ------------•-------•-----------•-----•-------------------------------- y _ --------------------•--------------------------•-----•--------••------'___••---------•-----•------_--__.. _._ ________________ """__________-__"_-____"__-____--_____--""__._____---_____"___-____________.--________-___._-_____-""--"-"""•-_________-_."""--_-.-__------""""-- _____.-_-----."__..-_.. prepared,this-a I hereby certify +hat I have pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and regulations of the San Joaquin Local Health District. - - •---------------------- - ---------------------{Awne�+Contractor] (signed)' tl ----------------------------------- -Ir el (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc:; can be placed on reverse side). FOR DEPARTMENT USE ONLY *_ DATE----- '--`--------------------------------------------- APPLICATION ACCEPTED BY-- ----------------- REVIEWEDBY------------------------------ --------------------- _._.. DATE -----•--------- BUILDING PERMIT ISSUED-------------------------------------- V ; ------------ --------------------------------- Alterations and/or recommendations:.___---._____-__. --- _ - ----•---------------- -- - ---------- --------------- ii ------------------•------------••---------------------- •--------------- ----•--------------- ------------------------------------ !I r7 � ------- ---------- Date-- ------ ---- - -- ----------------------------- ------------ FINAL INSPECTION BY:"._._"_-- •. - -- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street, Trac California Stock+on, California Lodi, California Manteca, California Y. 2M 145446 ATWnn❑ 12-54