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Py A' ,A ) �, � I APPLICATION FOR SANITATION PERMIT Permit No. --- �'`�i (Complete in Duplicate) Date Issued pplication is hereby made to the San Joaquin Local Health District for a permit to construc its application is made in compliance with County Ordina 549. t and install the work herein described. OB ADDRESS AND O ATION__.______.�--� - Owner's Name— /� /J ------------- Address { L --- Contractor's Name---- ---- ------ --- -------------- - - Installation will serve: Residence Apartment House _ Phone �y ° ' ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: ___- - Number of bedrooms -_ Number of baths __ __- Lot size __ 4 Water Supply: Public system Communit system -- X-` �---------------- Y ❑ Frivate ❑ Depth to Water Table��ft, € Character of soil to a depth o 3 feet:] Sand [] Gravel ❑ Sandy Loam [-] ClayLoam Previous Application Made: Yes No ❑ Clay ❑ Adobe Hardpan ❑ ❑ New Construction: YeSX No ❑ /T, TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) Se� Tank: Distance from nearest wel!_ _-Distance -from foundation__._. IJo`of compartments____. _ • ------.Mat - - ----- ----Size_. ----- -- - - - -- -- --------------------- Disposal ------ - --------- I X ----------Liquid depth ------ Ca acit --- de- Disposal Field: Distance from nearest well --_Dis}ante from foundation__-__ p Y S Distance to nearest lot line _47e' . Number of lines---- --- --------------- - Length of each line _� ` Type of filter matetial g - -Width of trench..__-2` �`�=`7�------Depfih of filter material `�--------Total length---�----,.�5-�-- ---------------- Seepa a Pit: Distance to nearest "-----Distance foundation---•------ Vfning 1 5---------------------- --- _ Number of pits__-.__. ._.____---- Lining material to nearest !ot line_____ _________ 1_.-_.Size: Diameter Fess ool: --- Depth__._.-- © ` ❑p Distance from newest well_________________Distance from foundation._-----.-----_ aterial__.___________.__- _- _---_ 5iz Diameter - - --- ---------------Depth----------------------------- Privy- F Liquid Capacity----------------------------gals. Distance from nearest well �,•� --------------Distance from nearest building--------------------------------- Remodel Distance to nearest lot line_ _ ___.___ ---- , Remodeling'and/or�epairing.(descrb :- _ _ - - ). G ' . - ---------------------• ---------- -- -- •-- ---- ------•-----------••-----•--•--------------------------------•----------------•--•---•------.._-•---------- -------- -- .---------------------------------- - --------- ---- _ - -- ------ ----- -- --- I hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County ordinances, State law a rules and regulations o he S Joe Local Health District. (Signed)_ f. Y ..: T� .1 __t___ ` ---__(Owner and/or Contractor) BY: = t ------(Title ��4 Plot plan, showing size of lot, locations f systern in'rela+ion to wells, buildings, etc., can bea p on reverse de). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ __� --- REVIEWED BY ----------------------------------------- DATE ------------------------------------------ , �l-------- ------------------ BUILDING PERMIT ISSUED-------•------••-, -- DATE---------- - - � -. --- --------------------------------------- Alterations and/or recommendations: D ---------- - -------------------- ----- ATE _�_ --------- ---- T14�...�' tu� r�_ � �� Sc_a �` --------------------------------- r� -------�L��}r.--- --•--•;---•---•-------•---------------4 4✓_-'S1Ea C ------- /ri/_ ----------------------------------- - ( p„-7- r� c.t ----------------------- _ �y FINAL INSPECTION BY_____________ te _ ll ,o, _ l -f_..__.______-__ _ Date . tf ". `,'' 7------------ ` AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M io-52 Revised W-2100