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APPLICATION FOR SANITATION PERMIT Permit No. _771� (Complete in D uplicafe) Date Issued _76�1R6- 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 JOB ADDRESS AND 0CATION..eV__/_4_------------ozj�-_O_ ------------—--- ---------------- Owner's Name------ 4 ------ ------ ----------------- --- ----I----------------------- - I- -------------- ----------- Phone...--------------------- Address...---------- Contractor's Name--------------------------------•---------------•-------------------------------------------------------------------------------------------- Phone I . Installation will serve: Residence K Apartment House E] Commercial E] Trailer Court E] Motel [] Other ❑ I 'Number of living units: Number of bedrooms cat Number Of baths -1---- Lot size fool-a6---.6----------------------------- Wafer Supply; Public. system Community system Privi F ate [] Depth to Water Table -------- ft. I Character of soil to a-depth of 3 feet: Sand E] Gravel E] Sandy Loom E] Clay Loam E] Clay E] Adobe<j, Hardpan E] Previous Application Made: Yes F NoIj< New Construction: Ye-9f' No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellhD4QMPAistance from foundation--l-b------------m aE riai----1�--- No. of compartments.--- -----------------size_�5_2_�__)(__'_5------Liquid depth------- ------ - --------Capacity---- _ --------------- 4 ' Disposal Field: Distance from nearest welL�� ."- fance from founclation-J,0 .o-----'Distance_-to nearest lot line._16. Number of lines-------- -------')-,0 4er, tl of each line-----&-d--- ----------�.Width of french---- ------------ Type of filter material. filter material---- ----.-Total length----- -------------------- of Seepage. Pit- Distance to nearest well----------------------Distance from foundation--,.,-,-------.____.Distance to nearest lot line-______.-_-______ `� ❑ ine------ ----------- ElNumber-of pits----------------------Lining material-----------------------Size: Diameter+r---------------------Depth----------------------•-----•- Cesspool: epth----------------- -----------Cesspobl: Distance from nearest well-----------------Distance from foundation-- -------------Lining material-____._-___-______.______--_______ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid -Capacity----------------------------gals. Privy: Distance from nearest well---------------- --------------- ---Distance from nearest building--_______..__.___--.___________ ❑ uilding---------------------------------171 Distance to nearest lot line-------------- --------------------- - ---------------------------- ------------- ------------------------------------------- Remodeling 'and/or repairing (describe):------------------------------- ------- ------------------------------------------------------- ti --------------------------------------------------------------------------I----------------------------------------- -------------------------------------------------- ----------------- - ------------I----------------------- ----------------11 --------------------------------------------------------------------------------------------------------------------------------------------------------------1---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws,and rules and regulations of the San Joaquin Local Health District. (Signed)------------ --------------------------11....... - ----------------- -- ------------ ------------------------------------------------------------------------(Owner and/or Contractor) By:--- -----------------------------------------------------(Tif le)------------------------------------- -------- ------------- S�owi g size.of I ------ ---------- (Plot plan, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ --------- -------------------------------------------------- DATE----- = REVIEWED ATE------ REVIEWEDBY:---------------------------------- -------- ------------------------ ------------------------------------------------------ DATE ---- ----- --------------------------------------------------- - BUILDING PERMIT ISSUED. DATE----------- .,. -------- ------------------------------ Alterations and/or reconnmendations:-_---'- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- ------------------------- ---------------------------- ----------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------- ---1--------------- ------------------------------------------------------------_----------------------------------------- j-------------------------- ----------------------------------------------------------- - --- ------------------------------------- ---------------------------------- ------------------------------I----------------------------------- FINAL -INSPECTION BY:--- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reof 300 West Oak Street 132 Sycamore Sfraef 814 North "C" Street Sfock+on, California Lod;, Californle Manteca, California Tracy, California ES-9