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Permit No. .,.L---,-t. APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Date Issued A-710 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 549. {' ------------------------------------------------- ---- -------- JOB ADDRESS AND LOC N_�__��Zjf---/-------------- -- Owner's Name o u F " i ---- LL � _ Phone _-" _CI� Address -- --- ------------------ Contractor's Name--------•-•----•-----------=-------- --- - __ - -----`-,-Tl V?` 41-------------------- ---------------- Phone.. .- C �r Installation will serve: Residence 9 Apartment House ❑f Commercial El Trailer Court El Motel L]/Other __� ❑ Number of living units: ___-;Number.of bedrooms __k Number of baths .:�_-_ Lot size --------------------- Water..Supply: Public system Community system ❑' Private ❑ Depth to Water Table .4�ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ` W 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------------------------.---_________.__-_____- r No. of compartments-----°- - Size------------------------------•-Liquid depth--------------------- ----Capacity-------- Disp❑osal Field: Distance from nearest well----------------_Distance from foundation--------------------Distance to nearest lot line____-_____---____ r ❑ Number of lines-----=-----------------------------Length of each line-----------------------`-----Width of french--------------------- -------- Type of filter material-------------------------Depth of filter material----------------------:Total length------------------------------------------A Seepage Pit: Distance to nearest well ? -I3istanc o n_ ®.___-___.Di t��ce to nearest lot I' e__1-_-_______._ Number of its- ___ -__--_ Lining mafe 'a-- ____ ______ Size Diameter-j _-___-.: Depth_.. _______________________ p Cesspool: Distance from nearest well_______________ Distance rom foundation-------------------lining material_________----____-____-_-___-_---__. ❑ Size: Diameter----------------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-____________-------------__________--.---------Distance from nearest building--______-____-----___________-__ - - ------------------- --- ------------------- ❑ Distance to nearest lot line---------------------------------------------------------- ` Remodelin and/or repairing describe -------- -----,_ -- -- 15; ---•-•--- ---------•----------------- -------•----------•---------------------- ------------------------------------------------------- ---------------------------------------------------------------------------------------••---------------------------••-----•---------------------------------------------------------------------------- - I hereby certify th ve prepared this application and-that the work will be done in accordance with San-Joaquin County ordinances, State laws,and ules and regulatons of the San Joaquin Local Health District. r -�� a Owner and/or Contractor) (Signed)---- ------------ ----- ------- -- -- ---- BY= - ^----- ----------------------(Title) ' (Plot plan,showing size of lot, location of system in rela on to wells, buildings, etc., can be plane w reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY� ----- ---------------------------------------------------------------- DATE:R- REVIEWED BY DATE_ ------------------------------- ------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------ - ----- DATE----- ,-------------------- -------------------------- - --------------------------------------------------- Alterations and/or recommendations------------------- - -- ---------•----•-----------------------••----------•- ----------------- -----•---------- ---------------------------------------------------------------- ------------------------------------------- ----------------------------------------------------- -----•- --------- -------- ----- ------------------------• ---------------------------- ----- ------------------------------- -. -----------------------•- --- - _j js (- FINAL INSPECTION BY:. Date- ---- - ------- -- =- -------------------------- _. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 est Oak Street 132 Sycamore Street 814 T<lorth "C" Street W Stock#ori, CaliforniaLodi, California Manteca, California Tracy, California .�� . ES-9-2M 10-52 Revised W-2100 r