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APPLICATIO N FOR SANITATION PERMITPermit No. . U' (Complete in Duplicate) A Applica{ion is hereby made to the San Joaquin Local Health District Date Issued __...G. This application is made in compliance with County Ordinance No. 549r a permit to construct and instal! the work her'e'in'dascribed / JOB ADDRESS AND L ATION_.________ .-- --------�_---------- wner's Name ---9----------------� -- ------- ---------------- ----- Address--•-------•------••------• ---- ------------------- ----- Phone----•�-----•- - --•• --• -•------•----. -_ Contractor's Name------- ___ g--"_._ J ---------•-----••-----•- ---•----- --- -- ----------- ---- Installation will serve: Residence ,,—� �� -------- "" " "` Phone 1�tt�npartment House Commercial C�-'�1£ar'� Number of living units: __.2.__- Number of bedroom �-_ - ❑ Trailer Court ❑ Motel ❑ Other ❑ • � 'Number of baths -_/-_ Lot size .____c5 _-- �_�� Water Supply: Public system ----- ----- ______ Y ��ommunity system Private ❑ Depth to Water Table 4? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay Adobe Previous Application Made: Yes ❑ e �, Hardpan ❑ ❑ No New Construction; Yes �Qo ❑ 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-_ -e7,C.�is#ance from foundation-_lp__r U. No. of compartments -----Material____<__a__ Sire__. Liquid depth---W/-. Disposal Field: Distance from nearest well Capacity-__--- �G§�_ stance from foundation--- •%_._..Distance to nearest lot -------- ----- C Number of lines_"____._____/__-•__.,_ Len th of each line___ -_' ` -•------•• Type of filter material.- "- r' - --- g �Q- ------Width of french------- �t ------------ Seepage - -----$J?f Depth of filter material-_-�-_ ........... Seepage Pit: Distance to nearest well_./ e �istance ,+ Total fen th-------�o------ ------ -------- �.__Distance to nearest lot Number of pits.-_-_--l_-__-._-----Linin mater line___ Q-�•- g �� p e: D meter----- x.�-----Depfk---�, _ Cesspool: Distance from nearest well---------________Dis# ce from foundati ~ - --------------- Linin material__._. - Size; Diameter.------- -- "-- --- _._Depth----------------------------------- -- --. ' �.._ �. n_ Priv rLiquid Capaci#y_. . -----gals. - -- Y Distance from nearestell=_�"' R _A ��g— 0•�,. __, _.._ -- --- - -- ------ ----Distance rom nearest,buildin'"} �' ❑ Distance to nearest lot line- --- "----- - g-------------------------- "`'�""� --- ------ ---•------------------- -------- Reemodeli �, and/or repairing (describ e�,:___._____.__ �I '_- ------ _ - -. � _ � "'�` � y --------- - ----------- ----------=------ 7A= �.- � -- -------- -- --------------------------•------------------•--------•-- �______ I hereby certify t I have prepared this application and that the work will one in accordance thl ordinances, State S. an rules and regulations of the San Joaquin Local Health Distnc . _ n Joaquin County (Signed)----- - --- - �--- ------------ -------------------------------- (Owner ner and/or Contractor) lo --- -- • ------------(Title) (Plot plan, showing size of._lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ REVIEWED BY DATE ------------- - -- ------- ----------------- -- ------- ---- --------------------------------------------- DATE--- BUILDING PERMIT ISSUED -- ti --- ---- ------------------------ -------------------------------- ------------------- DATE----.___7 - --- Alterations and/or recommendations:__.._-_"______________ ---------- -----------------•-------- --- •---------------•------------ -------------•----------------- -------------------- ------------------------•---- - - ~~ � ---------------- ------- --------------------------- FINAL ----- ------FINAL INSPECTION BY::...._ f. 4 .3 r r'-1 te----- ! - ------------------------ SAN JOAQUIN LOCAL HEALTH DIST 130 South American Sheaf 300 West Oak Street S+ockfon, California Lodi, California 132 Sycamore Street 814 North "C" Street Manteca, California Tracy, California E5�3-2M 145446 ATwaoo �y_sy