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Permit No A_-� APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Date Issued _______ A Henatn No District 549.a permit to construct and install the work herein described. nce islication is hereby made to the.San Joaquin Local Thapplication is made in compliance with County Ord -------------------------------------------- JOB ADDRESS AND LOCATI N_._.____._ -------------------------------------------------------- ta Phone Owner same ---------- ---------- Address---------------------------------------------------- ----------------- ----------------- Contractor's Name___________ ___ l oteOther,], Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ M ❑ S _____ Number of bedrooms � __ Number of baths �____ Lot size --- _�_/SW- ------------------------ Number of living units: to Water Table ________ ft. Water Supply: Public system El Community system '❑ Private a Adob( Ar�Pan [ICharacter of soil to a depth of 3 feet: Sand ❑ Gravel 171 Sandy Loam 171Clay Loam 171ClY ❑ Previous Application Made: Yes �❑ New Construction: Yes n"� \V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �/ Mate 'al------- . Septic Tank: Distance from nearest well_-------Distance fro foun on______ - Ca acit No. of compartments_______ _____________Size__ Liquid depth__-__.__ �- p Y __Distance to nearest lot line_ ____--__.Disposal Field: Distance from nearest well__--,�`�fDista ce from foundati4n (ptf Width of trench_______ ______ __ _____-_Len th of each line______Number of lines------------- g v --Total length------------- -- - �` Type of filter material_ __..-_Depth of filter materia0 Seepage Pit: Distance to nearest well__________________ __Distance from foundation-------------------- Distance to nearest lot line_________________ _______---------------Size: Diameter_______-------_------Depth ❑ Number of pits___-__---------------Lining material_ Distance from nearest well________________Distance from foundation -Liquid Capacity gal 4P Cesspool• -- q p Y--------------------------- ❑ Size: Diameter-------------------------------------Depth--------------------- ------------------------- Distance from nearest well------------------------------------------------Distance from nearest building______-__-___----------.------------------ Privy: -------------------- � ❑ Distance to nearest lot line-------------------------------------------------------------------------------- --- ------------------------------------- --------------- - ------ ---------------------- x ----------------------- Remodeling and/or repairing (describe)__________ ___ �1.0•.�.v�,_____________________ ------------------------- ------- ----------------- ^-�-- -------------- � - and ----- -- - -- --------- ----------- --------- - ------------ ------------ ------- - I hereby certify that I have predparedulahis tionsolf tation he San Johat-hLowork cal Heawilllbeth done cin accordance with San Joaquin County ordinances, State laws, and rules an g jt. (Owner and/or Contractor) Si _s------------------------------------------------------------------- (Signed))------ � ;: Tale ---------------------------------------------------------------- Plot ' Ian, showing sae of lot, location---- ---------- ------------------- ( p g f system in relation to wells, buildings, etc., can be placed on reverse side). FO`RDEPARTMENT USE ONLY 0 11 0111 �`l 11 111 ----- ------ DATE-------- -11 '- 101 APPLICATION ACCEPTED BY_______.------------------ ---!__� __._____----------- REVIEWEDBY-------------------------------------------------------------------- ------------------• DATE-------------------------------------------------------------- ---------------------------- --------------------------- BUILDING PERMIT ISSUED ----- ------------- Alterations and/or recommendations ----------------------------- _ - :___ t ---------- -------------- .J ------ - __.____ _ ----------------------------------- ------------------- ________ t ---------------- - - .�f - ----- --- ------------------- - n � _ -------------------------- Date ---- ---- — Date---------------------}---_-- -------•- -------- FINAL ----rFINAL INSPECTION BY:- ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT y 132 Sycamore Street 814 North Street. 1.5 130 South American Street 300 West Oak Street Tracy, California ' Stockton, California Lodi, California Manteca, California I E< ES-9-2M 8-51 Revised W-2100