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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S� Date Issued j Applica+ion 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--. -pate 2,- _B® 1� ,� auth-- urar --;ti`eri: Owner's Name---LeTL-A!----Tepx]- Address------Salute a� g -----------------------------------•--------- • Phone-_._11 --------------------------------------------- ----- --------------------- --------------- ------------ _-�. = on ractor's none ------- -•----- -------------------------------------------------------------------- ------------------------- ------------------- Phone.-_.-..---------- • Installation will serve: Residence [I Apartment House ED Commercial [I Trailer Court E] Motel ❑ O#her• ❑--------• ---•-- Number of living units: - -)Number of bedrooms -----2 Number of baths ---1-- Lot size ----. Water Supply: Public system �"--e�'�---'---------------------- Y Community system ❑ Private [Ij Depth to Water Table .--.$- ft. f Character of soil to a depth of 3 teat: Sand [it Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:', Yes ❑ No,E]x_New Construction Yes TYPE OF INSTALLATION AND SPECIFICATIONS: E] _No_L .,- (No'septic tank or ce�spool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material------- --------------_--_- ❑ No. of compartments- ---- ------------------Size-------------------------------- ------------------ DisposalLiquid depth CepacitY ---.----- r Field: Distance from nearest well----bQ--f'_tpis#ante from foundation----1,�-_-f Distance to nearest lot line_-----1©-__�' Number of lines-------3--------------------------Length of each line----.-6.0...x'_ Width of trench-._---_--�--#' " V) Type of filter material----_X 4G_Ck--------Depth of filter materia t. - ---�t----Total length-------fio---�-�-----•------------�- Seepage Pit: Distance to nearest well_.--_---_------------Distance from foundation -,-----.Distance to nearest lot line El 10 Number of pits----------------------Lining material----------------------.Size: Diameter----.----- ' Cesspool: ------ �-----Depth --------------------------- ❑P Distance from nearest wO----------------- from foundation.-.---------_------ Lining material-------.--_-------_ Size: Diameter -.. ... -- --- .------ Depth----- ------ --- ---------Liquid Capacity - ,-= �- -r-�» -•---gals, Privy:' Distance.from nearest vrell--� - -- -------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line----------------- g -------------------------- - ---------------------- - Remodeling and/or repairing (describe):-.------.- -----_ ------------------------__------- ! ---------- "! --------------•------------------------- -------- ----------------•-------•-----------------•---------•------•-----------------•-•------•------------------•----------------•------•------••--------------------------------- I hereby certify that ! 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. (Signed)- --------- -------------- --------------------------------------------- -------- -----------(Ow gY_.----------- ---•--------;;�:,.c��------------------------ __-�-------------_------- tTitle), :: (Owner and/or Contractor) (plot plan, showing Ss ie of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR-DEPARTMENT USE;ONLY APPLICATION ACCEPTED BY........ . ....r .� 1" REVIEWED BY V DATE--:-- B ATE-- - �.> -• ? E --------------------------------------------------------------------------------- DATE---•------------- ------- - -- BUILDING PERMIT ISSUED :3 --_ r ----- ----------- ----------•-- ----------- - DATE-. Alterations and/or recommendations------------------------- - -- -------------------- --------------------- --------------- --------- ----- Dat-•--- ------a.--------------- •--------- ----- - FINAL INSPECTION BY:-----= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stree+ 132 Sycamore Street 014 North "C" Street S+ock+on, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWMUD 12-54