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✓qc� APPLICATION FOR SANITATION PERMIT Permit No. _-�-.7.__l..rq-. (Complete in Duplicate) 7� Da+e Issued 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_-_--- 6tt r)Owner's Name--_- / �,r. ------------------------------------------•---•------------PhoneAddress.:. ------•------- -----------------------•-------------------- ---- Contractor's Name-__----te r-- (�/ �----- _. Phone Installation will serve: Residence EApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units. _- Number of bedrooms - - Number of baths ._1Lot size ----- Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table .0 - ft. Character of soil to a depth of S'feet; Sand ❑ Gravel ❑ ''Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: Yes No ❑ Adobe Hardpan ❑ ❑ �.-. New Construction. Yes � No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tano s ante from nearest well------ _---_--Distance from foundation--------------------Material--_---._.--_---._..-- GG N f compartments- Size.• == t •-------Liquid dept h--------------- ---------Capacity----------------------- Disposal Field: Distance from nearest well- Distance-from foundation-----------------.-_Distance to nearest lot line-----_-..--_----- ❑ Number of lines-----•-------------- ------Length of each line-------------------------------Width of trench Type of filter material-------------------------Depth of filter material-----------------------Total length---------------------------------------- Seepage Pit: Distance to nearest well_e--;; -�istance f m fogndation----le-.---.-_.Distance to nearest lot line--)-O . -fit('" [`� � -----•---- �- Number of pits------- ----------Lining material ize: Diameter----- . �- --- ----Depth..-�S'_.--•--------------- Cesspool: Distance from nearest well-----------------Distance from foundation-.----------------,.Lining material--_------_----.------_--- - _ Size: Diameter------------------'=-----------:-R---Depth-------------- -----------------.-------•--- ------ Liquid Capacity..-------•------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin g Distance to nearest lot line ---------------------- Remodeling and/or repairing (describe)------------------- -----------------------------------------------------------------•---•--------- ---•------ ---------•----------- I hereby certify t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, d rules and regulations of the San Joaquin Local Health District. (Sited)-------- ------- - - Byc � Zi r-- f Z (Owner and/or Contractor) L�-� _._ (Owne ------------------------ -------- -----(Title)-------- (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY---------------- ----_- - -__ - ----------- ---------------•-----------•--- ------ DATE......---- ---------- REVIEWED BY--------•------------------------ -------- ---------- ------ -------------------------- - - ------------------------ ------------------------------------------ DATE----i-------�• BUILDING PERMIT ISSUED------------------ 1: DATE: = ------------- Alterations and/or recommendations------------------------ ---------------------------••--•--- ------------•-•----•------ ------------- --------- ------------------------ FINAL INSPECTION BY_______________ _ '°� _4 3----------------------- ---- Date..... J f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 5tackton, California 814 North "C" Strea} Lodi, California Manteca, California Tracy, California ES-9'--2M 345446 ATWb- 12- 4 t