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APPLICATION FOR SANITATION PERMIT Permit No. -!� _5 ----------------- (Complete in Duplicate) Date Issued 2,;Z_40 Uf Applica+ion.is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hein descr* ed This application is made in compliance with County Ordiffance No. 549. JOB ADDRESS AND ----------------- L CATI --- ---------- --0-4. ------- _v --------------------------------------------------------------------- Phone-----------------------------I------ Owner's Name- __C�4 A... ------ ------ ---- -----------------------------------------------------7------------------ ------------------------------------------------ Address-. OOLO -- ---------------------------------------------------------------------------------------------- --------------- Phone----------------------------------- Contractor's Name------ --- Installation will'I.serve:- Resident e, 'Apartment House E] Commercial E] Trailer Court E] Motel E] Other ❑ 4 er-O Lot ................. "Number1hg. of IN/i _-unitsjF-'N6riib;rof bedrooms�T_'Numb— f.baths,��---I slze ---------- Water Supply: 06blic system 0 Community system ❑ 'Privat "f' Depth t- Water Table p o -F1 Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam El Clay Loam E] Clay El Adobe W' Hardpan ❑ Previous Application Made: Yes E] No K New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se t' Ta Distance from nearest well_________________Distance from foundation--.-----------------Material------------------------------------------------- tic TC No. of compartments--------------------------Size-------------------_----------Liquid clepjh----------- ---------Capacity----------------------- Field. is o-saI Field: Distance from nearest well------------------Distance from foundation Distance to nearest lot line_________________ Number ine----------------- Number of lines------------------- Length of each line------A7-of or, Width of french---- ------------------- Type of filter material--- _2 ------------------- - - -----------Depth of filter material______ -- --------- Total length--------- SeeageF1 L'.AOILDisfance from fpun sf le a line- Seepage Pit Distance to nearest well-- tion 1 r Number of pits-_ ------------Lining material ---- e p�n ---- Y A m e 'I from nearest well_________________Distance from foun at ion-------- ---------- Lining ------------------------ o'l es ool: Distance r-, Size: Diameter__. ___--- Depth---------- ------------------- ------------------------Liquid Capacify------------------------7----gals. 7— Privy: Distance_from nearest well_____.._____ _____.__ ____________Distance from nearest building------------------------------------------- ElDistance to nearest lot line -----------------------r------ ------ ------------------------- ----------------------------•------------------------------------ 1 ------ ------ ----------- ----------- ng and/or repb�ring ( 5C --- - - ---- W, 4 Remod - - --- ----- --- - - -------- - - ----- --- ------- A.... �_ �----- -- -- ------ -01-ox -- -------------------------------------------------------------------------- ---------------------------------------------- ------------------ - ---------------------------------------------------------------------------------------------I-------------------------------------- pljreb�y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawFs -and rules and regulations of the San Joaquin Local Health District. V 0, 1 1 T (Signed ------------------------------ ----------------------- 1------------------------(Owner and/or Contractor') By:---------------------'- -------------------------(Title)--------------------------------------------------------------- ---------------------------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------- ---------------------------------------- DATE-------------------------- REVIEWED-BY -------------- - - -; -_------------------_ --------------- ------------- ---------------------- 14 BUILDING PERMIT ISSUED------------ ------------ -- �4 .; V DATE ------------ T.;.+ -- Alterations and/or recommendations:-------------P------------------------------------------------ - - - - - -- -- ---------------------------------------I----------- -- ----------- - --------- --- ------------- -------------------------------------------------------------- - --------- -------------------------------------------------------- ---------------------------------------- -------�_. ---------- -- ___ __ t-----=_-� ....... ----------------------------------- -------------------------------- --------------- -------------------------------------- ------------------------------------------------------------------------- ------------ ---------------------------�-a------I--------------------------------------------------------------- ---- ----------- -----D--a--t------ --------------------------------I--------------------------------------------------------------------------------------- ----------------------------- - ----- FINAL INSPECTION BY ---------- ----- SAN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North."C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100