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1! APPLICATION FOR SANITATION PERMIT Permit No. __ _-------------- (Complete in Duplicate) Date issued -------------------- am—03 _----'am--03 Application is hereby made'to the San Joaquin Local Health District for a permit to construct and instal[the work herein-described. This application is made in compliance with County Ordinance No. 549. .._� 1 �'�'f 3 3 d.-5 4 c m.,e'..�.�•L.��;e u.,pc.J`12�- - i JOB ADDRESS AND LOCATION_ __fir L ---------------------__ -----_ �___ ___-_________' Owner's Name --------- ---- ---------- ----------------------------- Phone------------------------------------ Address -� '!r"_-�f-- `� ---------------- Phone----------------------------------- - -------------------------- - ontrac ors ame------------------------------ _ _ Installation will s rve: est len a Apartnt HH use Cmerci I _.ail r Court ❑ Mote! ❑ Other ❑ ju 5. 1 Number living u s „_. Number of bes _ .____ Lot size ------ ------ --- ---- -- -- - �.� �.....��..�.�--�=. ;.s::.�..-�ti-...- .�- . -.....,�,,,. ' - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe Hardpan ❑ Previous Application Made:' Yes ❑ N 0A,"',New Construction: Yes ❑ 1 No xr�,/, I TYPE OF INSTALLATION 'AND SPECIFICATIONS: .Q•v+�-a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi an Most of e from nearest well-----70-----Distancefrom foundation __0__r_____-Materia-______ _____________________ _ __________ compartments-----= '' 'Size � __ _.Licluid d pth �- '� Capacity----?-49--W-------- p 10-4 , : from nearest well_'_�_Q_____-_.Distance from foundation % _P�__ Distance to nearest lot line_ .____________ Number.,of lines--------- -----------------------Length of each line] __"1''_ '_ _____--Width of trench_____3 is e" i -stance --- Type ,filter material__c5_T •- Depth of filter material-------;1_,9 __t__Total length_____/_90________________________il See ge Pit: Distance to nearest well----� �________D- tante from fou dation---/------Distance to nearest lot li Number;of pits________.--________� rrg ma riaL_>1_ __b_ _ _Size. Diameter-----------------------Depth_-______ _� h - - , Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material______________________________________ t ❑ - Size: Diameter-----------------------------------Depth--------------------------_------------------------Liquid Capacity----------------------------gals Privy: - -Distance from nearest building---------------------------------------Distance from nearest well_____ ________ ______---- ___ ❑ Distance to nearest lot line---------------------------------------------------------------------------- ----------------------•------------------ kand/or - ----------------- Remodeling and or re airing (describe): ------------ }.,. i ---------------------- -- - -----=---------------------------------------------------- � ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------- -------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- --------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County t ordinances, State laws, and'rules and regulations of 4 a San Joaquin Local Health District. (Signed )� - (Owner and/or Contractor)---------- --- --- ---------------------------- BY= i - ----- -----------------------(Title)---------------------------------------------------- (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----- -___-- 1 -- . _ ., REVIENVI D BY = DATE ----------------------•----------- BUfLDING PERMIT ISSUED" �----------------------------------------------------------------- DATE - - Alterationsand/or recommendations------------ - - ---- ------,--------------------------------------------------------------------------------------------•---•------------•-------------- F ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ I ------------------------------------------------- ------------------------------- ---- ------------ -- --------------------------- '� FINAL INSPECTION BY:`---------- -- Date-- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stocktsn, California „ Lodi, California Manteca, California Tracy, California k B--9---2M 8-51 Revised W-21oo F