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�.-7-`-"'--A-�-�--- APPLICATION FOR SANITATION PERMIT Permit No. ' (Complete in Duplicate) Date Issued -° '--- Applica4-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 0r d' e No. 549. JOB ADDRESS AND L ATION---- Owner's Name--- ' P"&*. ------------- --- -------------------- - --- ---- --------- ---------- - ----- Phone------------------------------------ Owner's ------------ --------------------- Address----------------------- " Contractor's Name-------- - ------------------------------------------ -- , Phone.. Apartment House ❑ Co Number ❑ Trailer ifilWW otpl ❑ there❑ Installation will serve: Residence ❑ p Number of living units: - mber of bedrooms -------- Number of baths __� _ Lot size --- ------------------------- Water Supply: Public system ;/Zmmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character oP f soil to a de th of 3 feet: S;;�ONew Gravel ❑ Sandy Loam Clay Loam El Clay ❑ Adobe [+/Hardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes bg No ❑ 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___ ___________Material______._--.____-__.__--_________---_._____---- ❑` No. of compartments----- ------Size--------------------------- Liquid depth 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---------------------.Distance from foundation.........._--------_Distance to nearest lot line___-_____--_____ ❑ Number of pits-------------------4ining m terial------------------ ---- Size: Diameter-----------------------Depth . ------------- • + .Distance fro foundation------------------ material---_________.._. Cesspo Distance from ne r st wejjl___ gall. Size: Diameter _ lam----------- --Depth----- - Liquid Capacity---- -----g k Privy: Distance from nearest well --------------____--_.--___.__- _----___-_._Distance from nearest building_________________________________-------. ❑ ---------------------- -------- ------------------------------- ------------- Distance to nearest lot Iine------------------------------------ --------- - Rem4de4i --------------------------------------------------------------------------- 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, State laws, an rules and regulations of the San Joaquin Local Health District. (Signed) ----- - Title (Owner and/or Contractor( --- - - ------ ------ - - By---- --- ------ ---- ---- - (Plot 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 ,,..r DATE, -- BY---------- --------------4------ A.--'- ----------- ---- ----- -------- -- ---------- ------------ ------------'DATE--- --------------------------- -------------------- BUILDING PERMIT ISSUED. ----- -----------------------------------------------I---------- 1•�lr3 Alterations and/or recommendati ns--------------------------------------------------•-------------------------------------------------------------- -------------------•----•-------------- j - ----------- ------------ ------- - - T,.t -- - -- --- -- -- A ___ _ ------------ 2 r------- -------------------- a.� �* ------------ -- ------ ----' --------- ---------------------------------- _ v€ 1PLTIO0 ., Date---------- ----------- ------ -- ----------- -----------------------•---FINAL BY-- ---------------- ------------------------------iwdiSAN JOAQUIN LOCAL HEALTH DISTRICT war132 Sycamore Street 814 North "C" Street it 130.5oath Am can Street 300 West Oak Street Manteca, California Tracy, California $1.ockton, California Lodi, California ES_.-9-2M Revised W-2100