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I— A APPLICATION FOR SANITATION PERMIT )Complete in Duplicate) Permit No. _-./---• Date issued 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. 49. '� � .-. -------------------------------- JOB ADDRESS AN CATION__-- J' 1 -- ------ L� L/-- ------ Phone -----------•------- Owner s Name--------- -- - -------------•-----•--••- Address-..------• --- x�i�. � � �. ...... � .i� .. -•----•--- Phone--------------------------------- Contractor's Name------ ------------ ------------------ --------------- -- - A artment House ❑ Commercial o Trailer Court ❑ Motel ❑ Other E]Installation will serve: Residence p �-�: � _ _ Number of living units: -------- Number of bedrooms -------- Number of baths ; -_ Lot size ----- / Private Depth to Water Table _�-eft. Water Supply: Public system Community system ❑ ❑ Adobe Hardpan ❑ `-JCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam [3 Clay ❑ Qh Previous Application Made: Yes ❑ No U_New Construction: Yes a_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` -��-------- -,Material---�.�--��'`-/`=�=`=��-------•. Septic Tank: Distance from nearest well ---/ $r�tance from foundation__- - — Capacity ��----- No. of compartments Size •�J--,Y--bra.---Liquid depth P Y �'ol Disposal Field: Distance from nearest well_. !d} ��,� pistance from foundation__ ��.�-�----Distance to nearest lot line_-��..-• _--__ Len th of each line -----_---.-V--- ---- 1.Width of trench_------ .-Cf------ Number of lines ------ ----------•--,f g Type of filter material----�---1�(Z(Z Depth of filter material---..--_/-- ------ -Total length--_---. �.-------• �l�-j� Distance from foundation-.--_1.�C�--• Distance t4 nearest lot line .--_�------- "N Seepage Pit: Distance to nearest well__ -. - f" e. Diameter.-------' Deptn Number of its.---- -Lining materia l_--�� Cesspool: Distance from nearest well ----------------- from foundation------------------- Lining material --------------------------------- ❑ Size: Diameter----- ------------------------p ala. �t Dept ------------------Liquid Capacity -------- _--g Privy: Distance from nearest well ------------------------------------- -- Privy: from nearest building ------------------------------------------ Y� - Distanceto nearest lot line --------------------- --------------------- ------------------------------------------------------------------ --------------------------- Remodeling and/or repairing (describe):-...-- •--------------------•-----•---------------------•-----------------•------•-------------•-----•--------•-------------•---------•------- ------------------- ----------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ` ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. _________________--,---------- --_-_-(Owner and/or Contractor) Signed-- - ---------- - -----�---------- -------[ ' i-------------------------------------- ---------------------- (Plot -------------- (Title)-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- DATE------------•--------------------------------------------- -------------- -------------------------------- DATE------ - - REVIEWEDBY ------------------------------------------------- DATE------------- <-.1 BUILDING PERMIT ISSUED------------------------------------------------� -.. f ..-- --_..- -__ Alter tions and/or recommends ' s: - ---------••--------- .__i.'" �_--. - .. �- --, ------------------ -------.-.:-----------:----------------------------- --------- -----------------------------------------------------------------------------------:_----------------------- -----------:___ ---------------------------- . 1 -� FINAL ENSPECTION BY -------- ---------- - _ Date-.._- .�� ....... ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 130 South Amarie'an Street Manteca, California Stockton, California Lodi, California E5-9 145446 ATWUdD 814 North "C" Street Tracy, California