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APPLICATION FOR SANITATION PERMIT Permit No. _- (Complete in Duplicate) q w .f..r— m - i�,._. Date Issued ;9�1�3� Appfica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her-pin { This application is made in compliance. Dunt Or No. 549. ' described. JOB ADDRESS AND LQCATION Owner's Name-- c ' - ------ l v1 el--.... - - � ' ' Address------ �{�J n - �- ` _� - - ------------------------- -------- � Contractor's Name______ � p Phone--- Installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: I----- Number of bedrooms-.V--- pp� ❑ € Number of bafihs -�---- :Lot size .------ Water-Supply: Public system Community system ❑ Private ❑' Depth to Water Table e ft. �- Character of soil to a depth of 3 feet: i Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No;�j New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_A�Le-64s}ance from foun ation---- -----.Mat ria)__ r`-' - No. of compartments--________4 --------Size _ . ______Liquid dept _ °� ' ' -f-------------Ca acit` 6_ �' -- p Y a! Field: Distance from nearest weli::. r, l_ ---t.Distance to nearest lo} fine,.r �4 O7stance from foundation.._ as os Number of.lines l - y ----- -;-,,-�� Length of each line------- '4-----Width of trench_-_-• '_ - Type of filter material__1 t[1_'pepfih orfilf- r material-__._f�-4-_--Total' length-----_ �� F Seepage Pit: Distance to nearest welt- -------------------Distance from"66nda ---_30�____--_:D� to c�rto nearest lot line :.________ r ' 1 g — ----- Diameter. e�,3 f�I Number of pits------- '---- material_ i De th---.-- O p �=�------- 0 b esspool: ,. Distance from nea festo-�ell_-:_"_-______-:.Distance from foundation -------- Lining. material-----------------------�_ ❑ Siz_e: Diamefer__- ---- ---- ----- -.-Depth-- ------------ --------------L! :Liquid Capacity -- Priv C�� 'x . gals. Y=` Distance from nearest NveIL_:--__----_.,g------- ------------------_-- Distance from nearest b0din - . - ., a g - ------------------- ❑ Distance to nearest lot line_____________'__-_------- .w -- ------•---------- , emodeling and/or repairing (describeJ:------ ----------------- �---------------------:_ - -------•----•--#•----------------------- ----- Q ------------------•---------•---------------•-------------------•--------------••---------------------- --------------••-----•---------------------•------------------------------------------- I t ------- ---------------- ---•-----------------•-----••---------•--------------------------------- ----------------------------------- ordinances,._ } _ s . , F --- -•--- - - - -------- ------ --•--- ----- --- hereby certify that I have prepared this application and that'the work will be done-'in accordance with San Joaquin County II State s, and rukes and regulations of fhe San Joaquin Local Health District, -'�` A_ - C (Signed)--• " y _ 1 --------------------------------------------- ' E BY.,------ , (Owner and/or Contractor) , ---- wn --- ---------- •----------------------- (Title)------ - -------------------------------------- size of plan, showing of lot, location of system in relation fo wells, buildings, etc., can :be placed on reverse side). s r ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ----------- f. F -- ---- ---- --- DATE - ------------------------------------------------------- REVIEWED BY = : . �. --------------------------- ----- DATE-_`, - BUILDING PERMIT ISSUED ... . .^' ----------------- - =------------------- DATE------- -..-_'-- i Alterations and/or re ommendations_______ _ V t ---------------- ` = -•-------------------------- �'j t------ --'--- 1 - �..`� -------•-----..4---•-- --- - O -----_----•_•---------------' -•----•----•__-...--._._...--__•-•--_ ----------------.--^- --fey---'----- _.--•.----•-------•------------------•------------ •----._---.-•------------•--•---•----- - FINAL -INSPECTION BY:. ~- ---- - : ` ------ .- » ... Date_ .- ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 4 w ?� <s—o 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfockfon,'California Lodi, California Manteca, California . Tracy. California ES-4-2M ; Revisod W-2100