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ti. APPLICATION FOR SANITATION PERMIT Permit No. __4 r.`�..... (Complete in Duplicate) I Date IssuedApplication is 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. Y JOB ADDRESS AND CATION____/ -- �1 ? �•------------- ------------------------------------------- ---------------- Owner's Name------ - ---------------- Phone Address------------�i� ----- " .. ------ Contractor's Name__. - - •-'- ._. .. ---------• ---------=-------•----------------•--•-•--------------------------••---- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms%7--__ Number of baths -vS___ Lot size --- .____ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table tt. Character of soil to a depth of 3 feet: Sand [] Gravel Ej Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No �New Construction: Yes �lo ❑ FHA/VA: Yes ❑ No P;--1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w II_ }L.LDistance ff om foundafion__/X- _ _._.__ .Xerial--- No, of compartments---p' -------------------Size--- ___Liquid depth- _�_--'___-___Capacity___.�«S_Q__ Disposal Field: Distance from nearest weI1 Distance from foundation./,�----------Distance to nearest lot line--- Number iner Number of lines________ __ __ ______ Length of each line----7�_ _____.______.Width of trench__._y_-e�c_�`_____.__.____-_._ Type of filter material/ Z__��.._ Depth of filter material_____ ,_Total length------- --_--- ` _ ------------•---- Seepage Pit: Distance to nearest well-- R"Distance from fou ation_____'�__�_.__.,D to r� to nearest lot IineT_-��__.._ a Number of pits------4------------Lining materiall/1 _ Size: Diameter--�'...--____--.Depth----.r�_a�_---�-----__---- Cesspool: Distance from nearest well_-_____________Distance from foundation-----------------______Lining material--------------------------;________._. ❑ Size: Diameter---- ---------------------------------Depth---------------------------=-- ----------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line-- -------------------------------------- J ----------------------- --------- ---------------------------- eeo9r'Remodeling and/or repairing [describe]_____________ ---------------------------•--•----------------------------•--•-------------------------ti::------------=-----•----------------------------------------/_0 -_------------------------------ ------------------•----------•-----------------•----------------------------------•------------- -------------•------------------------------------------------------------------------------•------------------------------ ----------------------------------------------------------------------------------------------------------------------------------•--------------•----------------------------------..----------------------------------------- I hereby certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, anch rules and regu tions of the San Joaquin LocaL Health District. (Signed] - ------------------'(� -Contractor( By-------------------------------------- ---- -- ----- ----- -----------------------------------------------------{Title}__.�r�' �side) 0-------------- "0"plan, showing size of lot, to on of system in relafion to wells, buildings, etc., can be placed on revers FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ------------------- ------ DATE r-----••-•-•----••------------ REVIEWEDBY------------------------------------------ - -------------------------------•--•-------------------- DATE-------/;__. ---- PERMITISSUED-------------- ----- ------------------------------------------------------------------------ DATE---------- ------------------------------------------------- Alterations and/or recommendations. ------------------------------------------------------------------------ 1�1 -----------------•----- -•---------•---- ----- ----------------------------- -- - _ _ -- ------- ----•------------•-----.------ �, 1---------Pi-r---�� f' � {D n� -r__1 F. �u _.._Q t° -`----I-I`I�-------- ------------------------------•--------------44iW- _?*------ •+p/A" X F r'--------------------------------------------------------------------------------------------- FINAL INSPECTION BY______________ _ r ` - ✓--- ------------ Date ------- -- -----------------�-------------------------._.---- AN JOAQUIN LOCAL HEALTH DISTRICT . 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2 M , Revises 1.57 F.P.CO.