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o. APPLICATION FOR SANITATION PERMIT Permit N / (T (Complete in Duplicate) Date Issued ._�14_1� 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. 1 ---------/-- --------------------------------------------- -----------x# -- - ---- ---- JOB - -- -------------------------------------------JOB ADDRESS AN LOCATION _ - �j------ ------------ v - Phone __ ------------ Owner - --- ---•-- Address--=-------------- >/ / �--�-f---•---- G Contractor's Name----------- 1 - `- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms ....L Number of baths .__.I__ Lot size -----/S��_-----?5�-14q------------------------ Water Supply: Public system T__`Community system ❑ Private ❑ Depth to Water Table�v ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay loam ❑ Clay ❑ Adobe 2KHardpan ❑ Previous Application Made: Yes ❑ No 2--'—New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPEC lFiCATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se •c Tank: Distance from nearest well---.-------------Distance from foundation--------------------Material--------------------------------------------____. No. of compartments_ - Size--------------------------------Liquid dept ----------------- --------h _ Capacity ------------------:---- Di ROS4I Field: Distance from nearest well-__._..__._._-Distance from foundatiiion____________________Distance to nearest lot line___--_-______--__ ff Number of lines----------- ------Length of each line---------- ------------._----.Width of trench----------------------------------- J Type of filter material-------------- -------Depth of filter material----..-----------------Total length------------------------------------------- Seepage ---------------------------------------Seepage Pit: Distance to nearest wel{.__! 4? -Distance o foundation----�_d-------Distance to nearest lot line____._ p 0 Number of pits.-----1-----------Lining material-----------Size: Diameter--- --... -Depth---- -'r-------------------- 4 --l------- ----- Cesspool: Distance from nearest well----------------- from foundation....__.__._._.._ _Lining material------------------,__.____.___ 1S ❑ Liquid Capacity---------------------------- (� Size: Diameter---- �----�--- -=-�----�� ------Depth----- -------------•----�---�-- ---------- - -- g ' ________________Qistance from nearest building Distance from nearest.well.--------- -------- - _ Privy: - Distance to nearest lot line---- --- ------ ------ ---------------------------I------------- Remodeling and/or repairing (describe) ---- n----------------------------------------------------------------------------------•-•--------------•-------------..-. ----------------------------------- ------------------------ ------------------------...-----------------------------._.. ---------------------------- --------------------------------------------------*------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County f ordinances, St a laws, and rules and regulatioLes ns . the San-Joaquin Local Health District. Owner and/or Contractor (Signed).._ eW $y:------------------------------------- -------[Y-1t�`--- -------------�--[Title---�-�-°�w.�'--- Plot plan, showing size of lot, location of system in reI do o wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY fDATE APPLICATION ACCEPTED --------------------- ---- ----- ------ DATE----------------f BUILDING PERMIT ISSUED------------------------------------- - DATE------------- - - Alterations a d ori commencLations-------- ------- -- ----- -- - :--- ---- ----------•--- q--' :� - - Q..._n. lc_- ------- ----------- - . ..----•--•----•---------.. ------------------------ --- FINAL INSPECTION BY:...--- _---------------------- --- Date--------L4---- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300West Oelc Street 132 Sycamore Street 814 North "C" Street $+oak+on, California Lodi, California Manteca, California Tracy. California Er-9-2M 145440 PTWOOD 12-54