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Ii APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued I.`S 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. YtjJAVJ � 4Q J\Q. te-App is Y ,p } I JOB ADDRESS AND LOCATION__ - � - "'i Phone------------ Phone -------- Owner's Name r iY`e✓� -------------------- Address Phone----------------------------------- Contractor's Name----------------"•----------------------------------------------------------------------------------- ❑ Installation will serve: ResideFnce 54 Apartment Nouse FI Commercial E] Trailer Court ❑ Motel ❑ Other Number of living unitsi� ____---_ Number of bedrooms "_I"___ Number of baths -------- Lot size __ __ ^_-_ -C-)------------------------------------a Water Supply: Public- s sterni Community system. ❑ -Private,Z -Depth td°Water Table=4'�__"ft— >� pP Y y ❑ . Character of soil to a depth of 3 feet. Sand ❑ Gravel F1 Sandy Loam El Clay Loam [I Clay K Adobe E] Hardpan C1 iI Previous Application'Made: ,Yes E] No V4, New Construction: Yes C. No El TYPE OF INSTAI.LtkTION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 fee}.) 1 Q Material------Ca_► f-r ► ------ ----------- () �,' Fe L Liquid depth Tank: Distanceifrorn nearest well---_-C---"___"Distance from foundation- -___"_ -------- � -- Size------ - -- �- '-------- q p ---No. of com-partments__"""-C1�`------.---� � ---- ,� .- �, Distance from foundation._""ham Y' _Distance to nearest lot line_ Disposal Field: Distancel from nearest well- - " r '"` Width of trench -._ It---------------• iiof lines------ ------------1�""""-.- -Length of each line--_-_- ------ tt r E E Number 1 Tota! len fh___"-__ Type of',filter material-__-_:1- F '........Depth of filter material-_---_(_9""_""- g Lining material Size: Diameter-----------------------.Depth.--------------------------- --- p g its ---- i See a e Pit: Distance tf nearest well______________ "-- Distance from foundation--------------------Distance to nearest o+ ine___________-- fT1_ ❑ Number,o p it Cesspool: Distance from nearest well-----------------Distance from foundation___---_-._-_--- Liquid Caing pacity gals. Depth ----- ----- P Y.. ❑ -------------------------------------- -- ---- ---- Size: Diameter----------------- --- - -- - �� istance from nearesfi b�iildingY r - f ' -- isfiance rom nearest well--- ----- --- - --- "�Privy:'�." - Distance to nearest lot line------------------------ Elik Remodeling and/or repairing (describe):------—<---l/��----------------------------------------------•---------------- ,._ - ------------------------------------------------- ----------------------------------------------- ertif tha} I ---•-- -1 hereb-u--------- ---- - r------- p - y have re ared 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. --- --------------------------------------- --------(Owner and/or Contractor - - ------------------------------------------ Title ------------------------- L . t [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 p �� = DATE----------------------------------!�----- /"--------------------------------- -------`a-------------------- --. . PPLICATION ACCEPTED BY-,"""----- ------ ----- -- - "-�—� - -.^-��- REVIEWED BY --------------------- DATE_ ------------------------------- ------------------------------------- BUILDINGPERMIT ISSUED----------------- ---------------- --- ------------------------------------------------ -------- ------------------- Alterations and/or recommendations:--------_____-"-- ______-_"""-___""""-"""_-______""___"""- r -------------------------------------- ------- ----------------------- ------------------ --- - }` -- " -- -- ----- - -- ------- __ --------- r --------------------- --------------- FINAL INSPECTION B ----- ----" �j - ---------------- r, SAN JOAQUIN LOCAL HEALTH DISTRICT ] I 132 Sycamore Street 814 North "C" Street �7 130 South American Street 300 West Oak Street y Tracy. California Lodi, California Manteca, California Y� Stockton, California ` 8-51>Rnvise.,i.VJ-2100