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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued A plication is hereby made to the San Joaquin Local Health District for-a permit to construct and -install the work harem described. This application is made in compliance with County Ordinance.No. 549. - ' DRESS AND LOCATION--------lv__ -ie�-�-----'[✓-- ._ �7----- ---- -- -- -- -- ----- JOB AD , x"14- �1 ----------- ------------------------- Owner's Phone -. Owner s Name -- - Address------------------------------------------------- j� Phone {,� -t --�---- Contractar's Name•--------------------•-•-••---- -k� U Installation will serve: Residence 000 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 4� Number of baths/--.--- Lot size ---11----'a�--x''--�--�Q-�--------- -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table l Sand Loam El Clay Loam E] Clay F] Adobe ; Hardpan C]Character of soil to a depth of 3 feet: Sand El Gravel ❑ Y Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No 0.6A— A.R- ��'f.C_ TYPE OF INSTALLATION AND SPECIFICATIONS: YY// (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pficTank: Distance from nearest well--------------- Distance from foundation----------__----_--Materia4-------_--_-_---..---------_------_-----.------ iso. of compartments. Size-------- --------------•---=---Liquid depth------------- Capacity - Pal Field: Distance from nearest well-lY&A-1-Distance from foundation_-- _--Distance, to nearest lot liir Length of each line__.- -.�.-----------Width of trench-< ---------------------- { Number of lines- /r ----- g :• �i �7�, Type of filter material �-_� "3----Depth of filter material-__/{�_.-___ ---Total length------------------- -�--- i Distance to nearest lot line See ge Pit: Distance to nearest well.�_�--------Distance fro foundation-05-0S z Number of pits. -i---�----Lining material _ ��--_-Size: Diameter__o�__c�-�4........Depth---.--r�-�f--------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------_---- Lining material---_---_-------_----_-.-____-_. ❑ Lisquid.YCa.pacity;- = gals. Size: Diameter---------------------------- ---------Depth-------'---------------- ;r 'r�Disianceyfrom nearest welL--.:--------------------- ----------------------- Distance from nearest building_____------------------------ ---------- Distance to nearest lot ine----------------- -- ----------------- ----•-------------- --------------- ------------------------ ---------------------- Remodeling and/or repairing (descrisbe�:_--------------------------.-------- -------------------•------------------------ - ----------------:---•-------------------•---------- -------------------------------------------------------- €------------------------ ----- --------- --------------------------------------------------------------------------------------------------------------------- I hereb ce ify that I have prepared t ' pplication and that the work will be done in accordance with San Joaquin County ordinances t laws; apd rul ati land regal ns of the San Joaquin Local Heal District. contractor] ------- By:-------------- ---- -------- - - (Plot plan, showing size of lot, location of system in r laf o wells, buildings, c., can be pl on reverse side). FOR DEPARTMENT USE ONLY DATE -4 APPLICATION ACCEPTED BY- --- DATE------------------------------------- REVIEWED BY-------------------------------- ------------ ------------'------------- -------- DATE----------------------- --------- ---- -------------•-------- BUILDING PERMIT ISSUED----------------------------- ------------------------- Alterations and/or recommendations:-------------------- ------------------ ----------- --------- ------------------------------------------------------------ ----------------------•--------•-------------------- -------------- ------------------------------------------ - ----------------------------------------------------------- Date FINAL INSPECTION BY:-------- --- --------------------------- ---------- - -� ----- --------------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E5-9-2M 0-52 Revised W-2100