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" a Permit No. w APPLICATION FOR SANITATION PERMIT x (Complete in Duplicate) pate Issued Applica+-ion 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. \ .r ..--------- -- ---,------------------------- JOB ---- -•------------•--- JOB ADDRESS AND.LOCATION------p4V.G-- ---------- - ----•--'-------------- ----- - Phone e Owner's Name-- ----------- -- -------------- Address --- Address-----------------------s --------------- Phone --------------------•-------------- Contractor's Name----------- ----------------------------- Installation will serve: Resrdence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El I ---- Lot size ------------------------------------------------` ----•- Number of living unNumber of baths . its: -_------ Number of bedrooms Water Supply: Public system K, Community system ElPrivate.❑ Depth to Water Table _"""""__ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: Yes ❑ No S�_ New Construction: Yes ❑ No 01 TYPE OF INSTALLATION AND SPECIFICATIONS: - ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ""__ Distance from foundation_-lP---------Material... --------- No. of compartments Size ' ---Liquid depth-------- .Q"t---.Capacity------ ----- ------ I istance from foundation_"__fid--""..-.Distance to nearest lot line------- Disposal Field: Distance from nearest well__ !L�^- D Length of each line----------- --- - �" Width of trench.--------.L�1 ---------- Number of lines -2— �_ � ----�-�--- Type of filter material- L:.l�rz• -epth of filter material- �"�------dotal lengfih_-"""""_.__"""-".��"-"""-_------ Seepage Pit: Distance to nearest well-f ---------------Distance from foundation--------------------Distance to nearest lot line--------+_-.----. ❑ Number of pits-------------- --------Lining material"-..... ----- -Size: Diameter----------------------Depth.-----------------------r-------- -4 Cesspool: Distance from nearest well."--""_-""----- _piest+hce from foundation____ ______________-LiLining quid Capacity-.-"_""--__""""_"""____"�-------- ---------- \ ❑ Size. Diameter---------------------------- Privy: gals. p Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.------__-----_----------__---. ❑ Distance to nearest lot line---------------- -----•------ --------------------------------------•------------------ Remodeling and/or repairing {describe):------ `------. - -- € -------------------------------------------I--------------------------------------------- - - ---------- --------------------------------------------------- --- ------- ------- ------ ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la�S, Ialnd rules and regulations of +"e San Joaquin Local Health District. -` ------------ Owner and/or Contractor) 5�gned _{l ..-.. - - ------------- - ---- - - - - - -- --------------(Tif ------------- Tale ----------------- -- -------- --------------( )----•----------------------------------"------------------------ (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 APPLICATION ACCEPTED BY---------- -- ----------- ---- DATE `f� � REVIEWED BY-------------------------------------------------------------- - --- -------- -•- ------------- -------------- -------- DATE------------ ----�--------------------------- BUILDING PERMIT ISSUED------------- --------- DATE..--------------------------------------------------- Alterations and/or recommendations: """" "+' ------------ G ' ` -----------&I - �,G -- --- -------------- ------------------------------------- --------------------------- --- --- - -n - FINAL INSPECTION BY---------------------- ------------------ Date.- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+rest 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California Es-9-2M 145446 ATWndD 12-54f