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i s �1 APPLICATION FOR SANITATION PERMIT Permit No. .--_-- ----- I '3 (Complete in Duplicate) pate issued �!7-/--J�----- ltcation 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 jLCA TION----- --- ------ -------------------= --- -------- ------------------------------------ ---------------------- . 4'. -- --- ----------- --- ----- -- Phone-- - Owners Name----- ---/--------- lt�4. -------.... Address-___..-_ • q Contractor's Name............. -•--�s_.- --1- -- •----- Phone--l-' Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other E3L� Number of living units: ._I-_-_ Number of bedrooms --A,- Number of baths ---t__ Lot Water Supply: Public system [g""Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ardpan ❑` Previous Application Made: Yes ❑ No W New Construction: Yes &O'No ❑ �\ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic T nk: Distance from nearest well -S.-Distantpj from foundation- --l't_----_--.Material_ e--4 -- --------------=------------- --- K.4 No. of compartments----------cX------------Size d(,p--- .-X .Liquid depth-------�-----------Capacity.-l_ �a-----�- Distance to nearest lot line-��. +.-_. Disposal Field: Distance from nearest w I ,.Distance from foundation------ --�T- y Number of lines------------- __ _ __ Length of each line------------ - -Width of trench.-__.--a-/-----.------------ �► Type of filter material-_--_-7AP---- .---Depth of filter material-__._.- ._------Total length--_-:---- ------------------ s Q------.Distance to nearest lot line-�_- --_-- Seepage Pit: . Distance to nearest well--._'�Pw _Dsstance from un ation_---_ _---. I -------Lining material.-Q C.-----------Size: Diameter ..3- Depth vZ Number of pits-------- ___-- Cesspool: Distance from nearest well-----------------Distance from foundation------ -------------Lining material------___-- Depth -------------------------- ------- --Li id Ca it gals. Size: Diameter------ --------�- ----- ---- --- P uac Liquid pacify ------•,---�- -�----- Privy: Distance from nearest well-------------------------------=-----------------Distance from nearest building.------------- ----------, ❑ --- --- ------ - Distance to nearest lot line-- --------------------------------------------------------------------------- ----------------------- Remodeling and/or repairing (describe):-------- ----------- --------- ----------------------------------------- ------------------------------------------------------ -------------------------------------------- ----- ---- ------ ----- --- --- - - -- = I hereby certify that I have prepared this application and that the work willbe done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San oaquin Local Health District. ~ - ----------- G*mw and/or Contractor] .- -- - �- -------- ---- -a---------- (Signed)-----•--- - (Title]---- -- --- ----- - --- ------- -- By:..----•. - - --- ---------------------------- rse plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------------------------------------- .... -------- DATE-- ------------------------- -------------------------- • DATE----1 --- ---- ----------------------------------------- REVIEWED ----- -- ----------------•------------ REVIEWEDBY-------------------------------- --- ---------------------------------------- --- ----------------------------------- BUiLDING PERMIT ISSUED-------------- ----------------------------- ------------ ----------- - -------------------- DATE------ -- - =----- Alterations and/or recommendations:--------------------------------- ---------------------- q--- �----�---- Date------------f-f----------- - - --- ------ FINAL INSPECTION BY:---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-21M I0-52 Revised W-2100