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rrl..- ---•-- r�S1 Permit Na. --. - - APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Date Issued 3-1/ � --_ 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 is made in compliance with County Ordinance No. 549. / -----------•- JOB 'ADDRESS AND 1�0 ATION---------- --------f ------- -7 °'�,9 73 7 �_ � ---- -- ---- --,:,Phone- ---------------- ------------------ ----------- ---- Name---------- ------------- - D _-_- _----•------ -------- ----- - l Addressd-- h , --'-------------------------- --- --- Phone__.. _.---•-----------•--- - Contractor's Name-----------------------------•------------ ---'-- Other Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence partment House a le_D_�------------------- / .�_ Number of baths __I-- Lot size --a------- x - Number of living units: _f---- Number of bedrooms __ Water Supply: Public system F1 Community system ❑ Private [Depth to Water Table -----� ft' Adobe2r- Hardpan Gravel Sandy Loam ❑ Clay Loam ❑ ; Clay ❑ ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Previous Application Made.• Yes ❑ No New Construction_ Yes E] No 2—' TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public sewer is available within 200 feet.] ` 1 Material-__ '--C-------- Septic Tank: Distance from nearest well--j ------------ ------DI Bance from foundatiLn Liquid de th_ ---.-------Capacity_____ d-•---------- No. of compartments_... 5G 3� _ a p f Dis o_ .v- ------Distance to nearest lot line-__.--D----.-- .� p sal F' Id: Distance from nearest well_..._-.._a--_--Distance from foundation--,;- _ Length of each line-------S-d--------------Width of trench_._.��----------------•--- ^ Number of lines- /----------- g - ---------------------------------- 0 slgl ... ' Type of filter material_ jjkk--Depth of filter material--- ------Total 'length-----------------• - ----a gp r fqundation__________________•.D tance to nearest lot liinner____----------- �.,/Pit: Distance to nearest well________ _ _____--Distance f� L�" Size: Diameter- Seepage --- Number of pits____`_--------------Lining material___ __ __ _ Distance from nearest well-------------- ---Distance from.foundation______________'----.Lining material.:__..._-_-------------------- Cesspool: Liquid Capacity----------------------------gals. ❑ Size:-Diameter-------------------=--- ----- ------Depth----- ---------- -- q Distance from nearest building----------------------------------- ------- Privy: Distance from nearest well_._.____. __ __-____-__ ❑ Distance to nearest of me-------------------------------- -------- -- - - --------------- ---------------------------------------- Remodeling and/or repairing (describe :______-- __ _____________________ ------- - -•----------------------------------------•------- --- ---•-- ------ ------ ---- -•-- - that wo done I.hereby 'fy that I have spandare uihtions of thtion e San JaaquinhLocalkHeawill ltheDistr ctn accordance with San Joaquin County ordinances, S at yaws; and-rule 9 A-------•---------------------- ------------ n r and/or Contractor] --( `" e ---•------------------------ -- (Signed) By:----------------------------...... - -------- ----- ----- --- --------------------------------------(Title)------ -- - (Plot plan, showing size of Eot, location of system in relation wells, buiEdings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY DATE -------------------------------- APPLICATION ACCEPTED BY-------------------------- _ _ DATE_------------'-- ------- -----_------------ APPLICATION ACCEPTED BY------- ----------------------------------------------- -------------------- - DATE.. ' _____ _ _ _____ _----------------------------------------- _____•__•__•___-._-________ �_ -___.__•__..___- h BUILDING PERMIT ISSUED ------------- --------•------- r- Alterations and/or recommendations:--- _ ,., _--------------------- - --- -------- ------- --------------------------- ...__. - ---- --------------------------------------------- -- Date..._--------- r ----------- -------- FINAL . --------------------------- - F1NAL INSPECTION BY:.___ ._.__ SAN JOAQUIN LOCAL HEALTH DISTRICT Oak Street O West est e 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES"7 145446 ATWCCD .._. -