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s e97 O 3 APPLICATION FOR SANITATION PERMIT Permit No. _. v(Complete in Duplicate) Date Issued - 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 ty Ordinance No. 549. JOB ADDRESS AND LOCATION - e Owner's Name------------------------------------ ---- ---- -- --------------------- -------------------------------------------- Phone--"/--f r � Address. ---------- w .•v_/ury---,.------------------------------------------------ � f Contractor's Name------------------------- 1 - ------------------------------------..-------------•-------------------- Phone----9-''�7_�Q�-- Installation will serve: Residence ' Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ 4 Number of living units: __ - Number of bedrooms .d___- Number of baths I___,.- Lot size 4-49,-- -- S_ -------�----- ----------------------- Water Supply: Public system Community system ❑ Privat 'Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)< Hardpan ❑ -"Previous. Application Made: Yes ❑ No,X New Construction: Yes 9 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-'&OW-Ji---Distance from foundation.4-yF__-__._.___.Material_____ xNo. of compartments---_------------------Size_. _6 J,� Y-----Liquid depth-- "- ........ ------------- Disposal Field: Distance from nearest well__!'?� --.Distance from o ndation---1__� __-._.Distance to nearest lot line____8--"'_____ Number of lines_______________ _ --------Length of each line__--____-_- ---_._.Width of trench__ �f __ ___._ Type of filter material_____r�--/�/(___Depth of filter material__ -___�f_8_`_r______.Total length-------A-- .. --- - - Seepage Pit: Distance to nearest welf_.A4Xtt,------Distance fr m foundation---r _g._...___.Distance to nearest lot line------ Number of pits_._ ---------------Lining material Size: Diameter-14--2" — f ._ Cesspool: Disfance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- 0 Size: Diameter-------- -----------------------Depth-------------------------------•--------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------____----------------------------------Distance from nearest building------------------------------------------ El __._._--.__.__________ -_ --- ❑ Distance to nearest lot line f� Remodeling and/or repairing (describe)= = A -----------------------------------------------------------------------•------•----------------•---•-----------•--- ------.. ----------------- ------<- I hereby certifynan prep red this application and that the work will be done in accordance with San Joaquin Court+y ordinances, State la egulations of the San Joaquin Local Health District. . --- 5i ned i - ( g ) ------------- -------------- "t ----------------------------------------------- ontrac . - to r By----------------------------------- --- --------- - {Title) T S`1�s`t14 -- (Plot plan, showing size of lot, Location"of Sys. m in r tion to wells, buildi gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-- --- - ---- ------------------------------- REVIEWEDBY--------------------------------------------------------------------------- DATE ----- - - - BUILDING PERMIT ISSUED------------------------------- DATE----- -------------------- _" Alterations and/or recommendations------------------------------------------------------ - -- --------------•--------------------------------------------------------- ••-------------------------------------------------- ------------------------------ FINAL INSPECTION BY----------------- J -- ----- --=•a��. Date-- ---------- 3 -------------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street :` Sfock+on, California Lodi, California Manteca, California Tracy, California »k ES-9-2M 10-52 Revised W-2100