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APPLICATION FOR SANITATION PERMIT Permit No. .._ ��`-2:... \:•1 (Complete in Duplicate) Date Issued Application 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. JOBADDRESS AND LOCATION. _._ ............1�f...................................................................................................................... Owner's Name. AL - ------ Phone------------------------------------ Address , � - --------------------- �- - - ---_='..-.....- ---------- ---------------......................................................... Contractor's Name..... ticc ------------------------------------------------------------------- -----------------------------------•--- Phone----------------------------------- Installation will serve: Residence 29 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -)----- Number of bedrooms __1/ Number of baths .._1_-_ Lot size 1_Ao__- ...................... Water Supply: Public system 4 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth`of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ Previous Application Made: Yes ❑ No J4 New Construction: Yes J4 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 qh!t� Distance from nearest well--.---__--_---__Distance from foundation--------------------Material-__-_-_-_-__._-__-.-_.---_-___-____.---_---_. No. of compartments------------- ------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well__)_4%t,.._Distance from foundation----�O-----------Distance to nearest lot line----tom......... 14 Number of lines-----S1-K-e,_____-------------Length of each line-----L-o-------------------Width of trench.._. -----_._----__-_--_- Type of filter material._`.... --P—Depth of filter material----I_g_"-----------Total length-------�_o............................ Seepage Pit: Distance to nearest well____-.V-_______.-----Distance from foundation....................Distance to nearest lot line----------------- 1771 Number of pits---------------------Lining material..---------------------Size: Diameter............----------.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------_----__----_------_--_-.-_-___ Gj ❑ Size: Diameter--------------------------------------Depth-------------------------------------------------..-Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------- •----------------------------------------•----•- ----------------------------------------------------- pp / Remo in and/or re ir;n _ _(describe):--- ___ __ ___ _______ ____ .____._..._. .. ct1.-��.......,_ _ � --- ------ --- l -= ------- •-----•----- -------- -------- ----• --------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---�1�--- -... (Owner and/or Contractor) t" By:--- - 4l- i cols, (Title) (Plot plan, showing sl of lot, locaion of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- - ---- ----•------------------------------------------------------ DATE---- ----------- REVIEWED BY... -------------------------------------------------------------- DATE.-- BUILDING PERMIT ISSUED-------------------------------- -------------------------- --------- DATE 5:s- ....... ------------------------- Alterations and/or recommendations: = "� -- - ...i ---------------------------------------------------- •-------------------------------------------------- -------------------------------------------------- ... -----------------------------------•---- ---------------------------------------------------------- --------------...------------------------------------------ -------------------------------------•--•-------- --------------------------------------------- .................................. ------------------------------------------------ ....... --------------------------------------------------------------------------•-----•-- FINAL INSPECTION BY:.....ZIA,-)� ----------------------- `, f-�----�� ---------- Date...---- ---------- --------------------------------------- O SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+oekton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100