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APPLICATION FOR SANITATION PERMIT Permit No. �..__7 Y' (Complete in Duplicate) p` V 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION--------228- A P-e-im-ar--------------------------------------------------------------------------------------------------------------------- Owner's Name---------------r-Tho—mY-illiAID$---------- --------------------------------- Phone-- -----•------------------------ Address-------228---At---- 4—m—er---------------------------- Contractor's Name------------------------Delta ------------------------------- Phone---------37-3-953---- Installation ------3_-3955---- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _2____ Number of baths _1____ Lot size ----3.9492-___ Water Supply: Public system ] Community system ❑ Private ❑ Depth to Water Table ------ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [} Hardpan ❑ Previous Application Made: Yes [I No ❑ New Construction: Yes ❑ No ❑ 1 ` 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---3_QQ-----Distance from foundation------8t---------material-__---_S fteri'(±WbI`iCk--____. ❑ No. of compartments-------- 9._,---------Size------5A-X- 4ty.-4, ----Liquid depth_---&3A---------Capacitv__80Q----------- Disposal Field: Distance from nearest weI1100------.-.Distance from foundation--------- _--_--_Distance to nearest loft line-------- r Number of lines__-__---_------------------------Length of each line_I�4_------------------.Width of trench_____2___------------------------ Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------------:- Seepage Pit: Distance to nearest well----------------------Distance from foundation-_-_._._.-__....___.Distance to nearest loft line___.___-__--_____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________--___------_______________- ) ❑ Size: Diameter-------------------------- -----------Depth---------------------------------------------------LiquidCapacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________________________________- i ❑ Distance to nearest lot line---------------------------------------------------------------------------------------- -------- ----------------------------------------- I Remodeling and/or repairing (describe):-------------------New--------------------------------------------------------------------------------------------------------- ••-•••-------- t �. -----•----------------------------------------------•------------... --•------------------------------------------------------------------------------------------------------------------------------------------ --•---•----------------------------------•-------------•-----------.-..----------------------------------------------•--------•-----•--------------------------------------------------------------------------------•------- •-------------------------------•------------------------------..---•------------------------------•---------------------------••------------------•--------------------------- 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. t J (Signed)--------•-----------------D2l$$--------------------------- ------ - - -- - (Owner and/or Contractor) ---------------------------------------------------------Title Own er�-N� r. (Plot plan, showing size of lot, location of sysfe in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Pon APPLICATION ACCEPTED BY----- r -------------- DATE----//- %�I ---- - --------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------• DATE---------------------------------------------------- ��UILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------•-- DATE--------------------------------------------- ----- Iterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ------•-----------------•------------•------------------------------------- -----------------------------------------=----------------------------------------------------------------•---------------------------- --------------------------------------------------------------------------- ------•--------------------------------------------------•----------------------------_--------•-------------------- t ----------------------------------- ---------------------------------- V- t --------------- _ = " �L INSPECTION BY:--- - --------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Fpckton, California Lodi, California Manteca, California Tracy, California 8-51 Revised W-2100 ;