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i APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate Date Issued t ThiApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install thek herein described, s application is made in compliance with County Ordinance No. 549. w r AND JOB-ADDRESS C r � h� _ ION ------3?-Y........... 2:;�� Ac4,,, -5 Owners Name--------- -------------------------------._ _ f •---------•�--- ----- � f--•-�-•----- - Phone Address ------'----------- Contractor's ------•--on roc ors ame..-.--_..__._." --------•------•--------- - ---- -- - ----•-- --- --- - Installation will serve: Residence ElPhone- ❑ Apartment House ❑ Commercial Trailer Cour} ❑ Mot ------------------------ el [] Other 464 Number of living units: ..-_ - _.. Number of bedrooms -------- Number of baths -------- Lot size _��,__�` �'d �cJ: ��_ 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 C0a ft. Previous Application Made: Yes Na ❑ Y ❑ Adobe❑ Hardpan ❑ ❑ � New Construction: Yes �No ❑ FHA/VA: Yes-[]' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or'cesspool per if public se-wer.is available within 100,feet.),q - ., wad... .... �- .�.� v Septic Tank: Distance from nearest well' Distance from fpundat• n No. of compartments------- -----------.Size..l2 (a X / - - -• -------- ----•-------Liquid depth----�-- ------- -._'.�CapacitY---a Disposal Distance from nearest well---50------,Distance from foundation)l)_"_-..-r""-Dristance to nearest lot in isosal Field: Number of lines ---Length of each line-CA. .._ .. �/iclth of trench. _ __ Type of filter material".�a "--Depth of filter material_.._/_1'11_------Total length_------JO Seepage Pit: Distance to nearest well-" ---" ---Distance from'foundation--------------------Distance to nearest lot line-... ❑ Number Of PfA-----------------------Lining material-----------------------Size: Diameter------------------------ Depth--------------------------------- ----- ------------._.--___-"_ - Cesspool: Distance from nearest well................. Distance from foundation--------------------Lining material ❑ Size: Diameter.-------------------------- ----------Depth------------------- -g - Priv -- ---- --- -------- -----Liquid Capacity----- -------- ------- -.- gals. Y- Distance from nearest well................. -----------------------------Distance from nearest buildin -..r 4 i El Distance to nearest lot line g g""" ----------------------------------- ----------- i °�-r• *�"ag,( 'be} --------------- --- ----------------------------- ------------ ! / - ' `: ------------7 ----- '1 `' 4= I 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. `+_ - - (Owner and/or Contractor) { {Signed)..._--_ ....�� By:---- --------------------------------•------w .-- - :---��-��-- ----- --- Title)-------- {Plot plan, showing size of lot, location of system in relation to wells buildin s, etc., can be IacEd on reverse side}. FO DEN T ENT EON (19 APPLICATION ACCEPTED BY...... -___ ____ REVIEWED BY---- ---------------------- - ------ - �- -- �- � --•- - -•-."�- --. DATE-----� ..�-�.. ..-��.-.----------BUILDING PERMIT ISSUED --------------------------------------- ------ DATE ---- -------- ---- -- - ------------------- ----------- DATE-------------------------------------------------------------- - -------------------------- A aerations and/or recommendations_______ � -- � --------------------------------------- ------------------------------------------------ ----•------------- -- ----------- ---------------------I------------- ----- FINAL INSPECTION BY:.. ---------- _ _______ ----- ------------ Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Shee+ F 300 Wes} Oak Street 132 Sycamore Street Sta814 North "C" Street ckfon, Celifornie Lodi, California Manteca, California Tracy, California Revised 1.57 F.P.CO.