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`k APPLICATION FOR SANITATION PERMIT [Complete in Duplicate] Permit No. .�-�.__-- 1 Date Issued 1 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 CAT - •-- ------ -- ---'---- Owner's Name Phone_ -- � Addre s x ------------------•------------------------...--•------------ Contractor's Name------------------- 2-6----4, -- - -�- Phone---,7-- Installation will serve: Residence Apartment Hotis Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: ____j_ Number of bedrooms _�__ Number of baths _l___ Lot size __ --------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ElClay ❑ AdobAIV Hardpan ❑ Previous Application Made: Yes ❑ No New Construction': Yes,K No [] TYPE OF INSTALLATION AND SPECIFICA NS: '' `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ -.__Distance from foundation_/�Q__________,Material__._ - rc,� __ No, of compartments__�r . ---------------Size__ _ -j -_Liquid depth _�r, ,3 "Capacity___ C ___ Dis o al Field: Distance from nearest well-. d-�_-Distance from foundation_ _�---------Distance to nearest lot line---.r -- Number o7 lines-------- ---------- Length of each line________ Width of trench__..-_------ - ---------------- Type of filter material __ __ ___Depth of filter material----- - -��...Total length........0:40--E_ Seepage Pit: Distance to nearest well_---------------------Distance from foundation-------------------.Distance to neo est lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------..Depth... ----------- ----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------_------Lining material____!-------------------- . ---------- Size: Diameter Depth--------------------- --------- Capacity---------------------------gals. El Privy: Disfance from nearest well____________________________ ______._Distance from nearest building _ _- . Distance to nearest lot line---_--------------- ---------------------------------- ---------------------- Remodeling and/or repairing (describe):------------- _ .._ ;x___ � ----------------------------------------------- , -----------------------------••----f--.......--------•-------------------------- ------------ ».------' - ----- ---- I hereby certify that I have prepared this appli ion and that the work will be done in accordance with San Joaquin County ordinances, State, and rules,a*,;ifegulations th San Joaquin Local Health District. (Signed)9 ) --- -•-- --------�------------- --------------------------------- wrier and/o C ractos) By:__... �_ �= Title)_ . (Plot plan, showing size of lot, Iota ' o system in relation +o wells, buildings, et�canbe plon reverse sid FOR DEPARTMENT USE ONLY NLY APPLICATION ACCEPTED BY ' t', DATE ' -------------------------------------------- REVIEWED ;,7. -'5.3 -----._-- I WED BY-------------------------------- - - ----------- -- ---- DATE --------------------- ----------------- BUILDING PERMIT ISSUED--------------------------------------- ------------------------------------------• ------------------ DATE------------------------ Alterations and/or recommendations:_-_._---------------------------------------- --------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- .. ----------------------------------------------------- ----------I------------------------• --------------------------------------------------•---------------------- i FINAL INSPECTION BY:.____.__ -.� Date ' ------------------- ----- f SAN JOAQUIN LOCAL HEALTH DISTRICT - X130' h American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street �* 5, Cefiforia Lodi, California Manteca, California Tracy, California FW9-2M �evjsed -21b0✓ .fz l