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f - �� APPLICATION FOR SANITATION PERMIT Permit No. ..�. __._ __.. (Complete in Duplicate) ?/12) /DateIssued -f`S 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. JOB ADDRESS AND LOCATION....__f�01--- i, Owner's Name � FA14-------------------------------------- -- ------------ Phone- ------ Address------••---•------------------------- �G` Contractor's Name----------•-------•---••- 1 --------- <--------------------------------------------- ------------ Phone-- 9-="_OP ------- � Installation will serve: Residence L] Apartment House [-] Commercial ❑ Trailer Court El Motel ❑ Other El Number of living units: --/-- Number of bedrooms R_- Number of baths I___ Lot size ------.__-__-_._---------_ Water Supply: Public system dg_Community system ❑ Private ❑ Depth to Water Table 4<0 ft. i Character of soil to a depth of 3 feet:'. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe , Hardpan p Previous Application Made: Yes ❑ No2L New Construction: Yes ❑ No ❑ TYPE Of INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ' Tan Distance from nearest well_________________Distance from foundation__________________Material____._.______________._.____-._____.._.__..___.. No. of compartments--------•-----------------Size-------•------------------=----Liquid depth------------------------Capacity-- TLUerinal Field:!/ � Distance from nearest well ? - .--.Distance from foundation__ ---__._.Distance to nearest lot line------- Number of lines------ �r___ _ ___Length of each line___��_!__ Width of trench_.____S!Cr-. ---- 91 / �` r Type or filter material__-f_ __1 ----Depth of filter material___._] -- _Total length4_40_ ---------_------------------- Seepage __________________ p g r c�O__ ------Distance to nearest lot line__-- r._ See a e Pit: Distance to nearest well��'-________-__pistance fr m f undation__ ► Number of pits------__---_-------Lining material!__. -- -_ ;___.Size: Diameter._..j,3 -_--- Cesspool: Distance from nearest well-----------------Distance from foundation___-----------------Lining material _-______..___..____.___-____________- ❑ Size: Diameter------ ------Depth----------------------------------------------------Liquid Capacity----------------- ----------gals. O Privy: Distance fl rom nearest well_------_______---------__--------_-------------Distance from nearest building----------.__.__________-.._______.____._- ❑ Distance to nearest lot line------------- ------ --------------------------------------------------------------------------------------------- ---------------- Remodeling --------------Remodeling and/or repairing (describe):------- ------------------------------------------ --------------------------------------------- --•---------------------------•------------------------- ------------------------------------------•-•-----••----------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------•-- --------------------------------------------------•-- ---------•-------------- I hereby certify that a prepared this application and that the work will be done in accordance with San Joaquin County .� ordinances, State laws, a d rule and]regulafi sof the San Joaquin Local Health District. r„ (Signed) -------- = - ---------------- - -- ---- ------- - ----------------------------------------------(Q +r Contractor) BY: I ---- 1 lis ---------------- (plot plan, showing size of..lof, location sof system in relation f wells, building etc., can be plated on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ------ -- DATE-----------__-'-}- REVIEWED BY---------------------------------- ----- -- ----- ---------------- DATE ` �� Y.- ---------------------------------- BUILDING PERMITISSUED-------------------`--------------------------••------------------------------------------------------- DATE_-- Alterations and/or recommendations:-- ---------•------------•------------------------•--•-----•---------------------------•-----------..--------------------------•------------------•------------ -•-- ------------- -----•------------------------------•----------.-•------------------------ ---------------------------------------------••-------------•-----------•-------•------------------•------------------- 1 ___________________________________________.___.____.________________._ _ _ ________.______..._..___________..__.________-._._.._-_______._______._.____.._________.._.___________________ I FINAL INSPECTION BY:............ _ pate__.....--6-_J- r f ` ------ 1------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Scufh American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-2100