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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) j, Date Issued �.:a - Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d 'bed. This 6pplicafion is made in compliance with County Ordinance No. 549. Co�. ppscp e JOB ADDRESS AND LOCATi0117Z,_L_,. Zj--------- --- --- —----- ---r-------------- Owner s --------------- Owner's Name_ PI: -- ---------- ------------------------------------Y ------------------------ --------------------------------------------- Phone Address--------- ------------------- -------- -------------------------- ------------------------•- �_ Contractor's --------------I---------------------------------------- Contractor's ------- ----------- Installation will serve.- Re idence Apartment House E] Commercial F] Trailer Court E] Motel [I Other E] Number of living units: Number of bedrooms ._"Number of baths .1____ Lot size Z Wafer Supply: Public system E] Community system E] ' PrivateDepth to Water Tablej;?-b ft. III" Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam)jd Clay Loam [:] Clay b Adobe ❑ Hardpan E] Previous Application Made: Yes F1 No� New Construction: Ye,)<,No"'0 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__�M-------Distance from foundation---)_.0---------Maerial---- --------- No. of compartments-------)-- ------------Size- 6 - - kzcl depth---- �pui - Capacity.-- line____ Dispose"Field: Distance from nearest well_._Z�------Disfance f6m founclafion-.4-0-----------Distance to nearest lot Number' of lines------- I- -------- eng of each line---44-0-4W. 15 Width of french--- terial- lli� Type of filter ma of filter maferiaI__k_t___-----------Total length----___ Z-0--e------ Distance to nearest well---'Z 0------------Distance from fours oation--- Distance to nearest lot line---- ------- Number of pits.__-J---------------Lining material` �_ A�-r Diameter-----_3_1� St __.._.__lok I Depfk----- ------------------- Cesspool: Distance from near t est well----_._____--_-.Distance from foundation---------------- -- Lining material---.---_. -_-_----- --------------- F-1 S;ze. Diameter------------------- ------------------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Dis'fance from nearest well-------------------------------------------------Distance from' nearest building-- _---_----_____----____--__-_=______ ElDistance I fo.nearet'st lot!line.------------------ -I--------------------------------------------------------------------------------------------------------------- ----- Re odeling an or repairing (describe):_ ------ ------ I------------- - ----------------I---------------------- ------------------------------------------------------------- ----------------------------------4—-------------- i ------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------------------I-------------------------------------- ------------------------------------------------------------------------------------- �g an or ................... ........... ...... ..... I hereby certify that I have prepared this application,and-that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and recAations of fh�eSan. Joa uin cal Health District. (Signed).... ------------ ------ (Owner and/or Contractor) -- -- -------- - - ---#�4 -_�A__ _ .-7--- ---------------- By:- ---------------_------------------- -------!-------------------------I- ------------------ ------- ---------- (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----------_-------------- REVIEWEDBY------ -------------------------------- ---------- ----------------------------------------------------------------------- DAT -------- - -N ----------------------------------------- BUILDING PERMIT ISSUED----------------------- ------------ ------------------------------------------------------------- DATE--------- ---------------- --- Alterations and/or recommendations:-------------- _------- ---------------------------- - ---------------------------------------- ------------------------------------- ------------1i --------------------- ---------------------------------------------------------------------------- ----- -----------------------------_------------------------------------------------------------- --------------------------------------- ------------------------------------------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------ ------- ------------------------- --------------------------------------- --------------------------------------------------------------------=------------- --------------------------------------------------------------- 591 flrel----------_-------- 'Date-------------------------------------------- FINAL INSPECTION -BY:------ SAN. BY:--------- SAN,JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised W-2100