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_T APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 1y s ict for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health DistrI This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION �-t------------------------'�//� � v ------------ $T -_,(� ----------•- . -� ---- ---- ----------------------- Phone 1. Owner's Name-------------------•-- ---,-, , •-------- Address d1/L' '----•-------•---------------------•--------------------•------------------ - ------------------------------------------ -- 1 one Contractor's Name-------------•--------•--------------- ---------�``��-- --------------------•�-------- ---•---------------------------------- mmercial ❑ Trailer Court ❑ motel Other [3Installation will serve: ;Residence %, Apartment House [I C6 ❑ x �/O ------------------ ---- Number of baths _ -_---- Lot size ---- --------- Number of living units: -------- Number of bedrooms --Z' / _ g + Water Supply.l Public syste 1 ',Community system'❑ Priva-te F1 Depth to Wa#er Table -------- ft. V 11 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes�• No ❑ New Construction: Yes 2 No ❑ 4. f TYPE OF INSTALLATION AND SPECIFICATIONS: L (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-."" _----- Distance from foundation_-.-�_d_---____.Material!- ------------------ ---- �' Liquid depth . - Capacity-.----._.,. i No. of compartments-_---- �'".---------Size__4 -- Dis os I Field: Distance from nearest well __�..-_--_Distance from foundation_---_-��_!----_-_.Distance to nearest loft line'`-- Num_ ber of lines _._.___—-------------------Length of each line--- _-�a -�r-------Width of trench----------�----Depth of filter material- ---- ----------Total length------------------ Type of filter materiat Seepage Pit: Distance to nearest.well------------------ ---Distance from foundation'__ ._----_______.Distance to nearest lot line--._-----_.--____ Number of pits`"`�'`..'-- - -Lining material------------------- Size: Dia`meter Dept h f n ❑ �J l ' Cesspool: Distance from nearest well----------`��-Distance from foundation_--._.-.._---__--..Lining materia--------------------------------ale. ".� Depth ---------Liquid Capacity; -------------------9 ❑ Size: Diameter------------------------------------- ro Privy: Distance from tnearest well.-_--------- #------------------------------- Distance from nearest building----------------------------------------- - ❑ Distance to nearest lot line----------------= r - ------------------------------------------------------------------------------- ------------------------- - --------------- Remodeling and/or repairing (describe)------------------------------------ --•---------- ----------------------------------------------------------------•--------------= ------------------------- ---•--------•--------------•---------- --------------- ------------••-- ----------------`----•-------------------•------------ tI --------------------------------•--------------------------------------------------------------- ------------------------------------ ---- 1 hereby certify that I h ve prepared this application and that the work will be done in accordance with San Joaquin County 1: ordinances, Statw; an� ules and7regulat�of the San Joaquin(Vocal ealth District. 6 ------------------------------------------(Owner and/or Contractor) (Signed)_;L. -. .. -- --------------(Title) QY� can be placed on reverse side (Plot plan, showing size of lot, location of system in relation to wells, buildings,'etc., }. F FOR DEPARTMENT USE ONLY - ------------------- APPLICATION ACCEPTED BY----- ------------------- - - -- -------------------------- -- DATE l© � DATE----------------•------------------------------------------- REVIEWED BY---------------=----------------- =- ------- ------ DATE -----•------ •- BUILDING PERMIT ISSUED------------=-------------- ------ , --------------------- . ---------------------------------------------------------------Alterations and/or recommen ations_________________--.__ ----------- ---------- ---------•-------------- ----------------------- ----------------------------------------------------- ----------- 415 Z, :6 Date--..1 -- ------------------------------------ FINAL INSPECTION BY:..----- ------ ----- -------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ! Y ES-9-2M 10-52 Revised W-2100