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~� 1 APPLICATION FOR SANITATION PERMIT Permit No"_f1 ;-.z..•.- (Complete in Duplicate) Date Issued __---- Applica{ion is hereby made to the San Joaquin Local Health District fora Permit to"cot uct'and install O work herein described. This application is made in compliance with County OrdinancQ No. 549 JOB ADDRESS AN OCATION_.__ r ------ - -------- - -- 1 Owner's Name_ �C --------- - --- ._ Ph ne-------- Address ,7 ----------------------- ------------- - --------- Contractor's Name___ ____ --------- p ----------------------------------------------------- Phone. -----•--------•--------•---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __- _ Number of bedrooms -A,- Number of baths .-_��-___ Lot size Water Supply: Public system �---------- r Y ❑ Community system RR Private p 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 ❑ Nor.❑- New Construction: Yes QZ_ No E]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 -�-"Distance from foundation_ t V l—-----------.Ma l7 ' No. of compartments . Size � -- -- . ___X'1--•--_Liquid depth-_- Capacity J� Disposal Field: Distance from nearest well_ ___�".".Distance from foundation_.___:�U""--"-Distance to nearest lot line_____""""_-• Number o{ fines___"__--____." Length of each line____10_1 X-�'�x d#h of trench-__ - ,� f � Type of filter material___ �_�k--Depth of filter mai-erial.../ g--------_--Total length---, gC--�-----------•--•---- Seepage Pit: Distance to nearest well_ _ _Distance from foundation-------------------Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material-- •--------------Size: Diameter---------------------- Cesspool: Distance from nearest well-------------- Distance from foundation----- --------------Lining material___.__-_______---___ . ❑ Size: Diameter---------------- ---- 1 ------•----- Depth -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------- -- Distance from nearest building ❑ Distance to nearest lot line. __-_- _ ,I. ---------------- ------- Remodeling and/or repairing (describe)_________________________ ----•-------------•------------------------- -----•------•------•---------••---•---------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances�, , nd rules and regulations of the San Joaquin Local Health District. t (Signed) � ----- ------------------------ / - •-------------•-------- -- Ow BY:-- E i` ---"--(Title)-.-fir- (Owner and/or n d/oContractor) ------------------------------------- (Plot plan, s owing 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_ REVIEWED BY-------•----- - - �---�-----••-•--•----- -- ------------------------ ----- BUILDING PERMIT ISSUED - DATE - - Alterations and/or recommendations:--- -1----- ----- - - mala;--------- ------ ----- _- ------- ------------------------------------ --------------- a � �--�-�:a--:-� / � •------------------ -------------------------------------------- ________________________ , ______________________________________ FINAL INSPECTION BY:_.___-".__-____ 1 ------- ------- SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 South American S+reet 300 West Oak Street 132 Sycamore Street 814 North Stockton, California Lodi, California Manteca, California "C" Street Tracy, California ES�9 245446 nrwooa