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/d- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S 7�` ✓� } L,\V� Date Issued •••------- ------- 1 /1 �, 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. tom... � �� ®-- , JOB ADDRESS AND LOCATION _ ` ! i----uL [X ----------- Owner's Name----------- --------------------------------------------------- Phone Address -------------------------- ' J Contractor's Name-----------------4� ------- ------------- -------------------- ------------------------------------- Phone -------- . ----•-. •----... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ � r �', Number of living units: .-I---- Number of bedrooms .v -_� Number of baths ____ Lot size _______ _ •----------- Water __ .__Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C] Adobe Hardpan ❑ Previous Application Made: Yes E] No X New Construction: Yes E] No '� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well. (stancefrom founJda�iion... -•------Mate I__... No. of compartments-------- _-________Size-----3Yj,_�L.A[ek,iquid depth-------- Capacity 1_. Disposal Field: Distance from nearest well_________________Distance from foundation--..................Distance to nearest lot line---•----------. .O❑ Number of lines-----------------------------------Length of each line------------------...........Width,of trench----------------------------------4k4 Type ---..---. _____-_.---___---- Type of filter material_________________________Depth of filter material_____...___-____-__----_Total length----------------------.................... SeepagePit• Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__............... ,0Q,, ANumber of pits----------------------Lining material-----------------------Size: Diameter-----------------------:Depth--------- CevpboL• Distance from nearest well.................Distance from foundation--------------------Lining material-------------------------------------- 1-1 _---_•_-_ ._--_---.-_---_-•-_❑ Size: Diameter------------- ------Depth---_---------------------------------------------Liquid Capacity----------------------------gals. Privy Distance from nearest well---------------_--------._.___-----------------Distance from nearest building_-___ _-----•-___-___--------•_--_____- ❑ Distance to nearest lot line-----------_---------------------------------------------------------------------------------------------------- Remode)i'ng nd re iri ( tribe) at.4 '-" � . (.T7��r----- -- ----- ----------- k�� -----------:-----------------------------------•-------------------------------------------------------------• --------.................. --------------- -----------------------------------------------------------I-------------------------------------------------- ....................................--------------------------------------------------------- --- I hereby certify that I have prepar, application and that the work will be done in accordance with San Joaquin -- -County ordinances, ate ws, and r a re ions of the San Joaquin Local Health District. (Signed, -- -----f � = ------------------------------------------(Owner and/or Contractor) BY'-------- ---------------------------------------------------------- ----------------•------------------------------------------(Title)-------------- --------- ---_------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., an be placed on reverse side). F DEP E T USE r APPLICATION ACCEPTED BY-------- ---- ''-- - ------- ---------------------------------- DATE------ y f'" _-----_------------- REVIEWEDBY----------- -----------•---- ------------------------------------------------------------- DATE _ BUILDING PERMIT ISSUED------------------- ---- _---------_ DATE----------------------------------------- Alterations ------------------------------------Alterations and/or recommendations:----------- -------- ----- - -------------------------------------------------------------------- ---------- FINAL INSPECTION BY%_____________ ---------- Dater J--- SAN JOA UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycareore$6set 814 North "C" Street Stockton, California Lodi, California Mantecaalifore;a Tracy, California ES-9-2M 8-51 Revised W-2100