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%= APPLICATION FOR SANITATION PERMIT _ Permit • i (Complete in Duplicate) Gr bate Issued — i 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. • r --- ----------------------------- JOB ADDRESS A"ND LOC 110 - ---- -- ------ - - - -f---O---------- ---- ---------- t P-7 -- ------- Owner's Name------- '--- ------ Phone----------- 7 Address------- - - ---------------------------------------"----- - -------------- Phone----------------------------------- Contractor's Name------ - ---------------------•-----•------------ ---------------- --------------------------------------------------- Installation will serve: Residence Apartment House ElCommercial E3Trailer Court El Mot?] ❑ OtherP El Number of livingunits0 K . --�_-- umber of bedrooms _-�--- Number of baths -1-_-- Lot size ----�------------------------------------ ---'------ -=-- Wafer Supply: Public system [Community system ❑ Private ❑ Depth to Wafter Table -------- ft. Character of soil to a depth of 3 fee : Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe 2/Hardpan ❑ Ch P r 4 SG Previous Application Made: -jYes No n New.Construction, Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Mat r'al_ 64_' - ----- ---- Septic Tank: Distance'from nearest weft_`�''`_."--Distance fro foundation________________ ---- • -------------Capacity _- [� No. of compartments-----------"-�--------Size__--' - --X -5 Uqusd de/ th------------- Dis os 'Field: Distance`from nearest well---.----__--.-Distance from foundation-- fa--___.D'sstance to nearest lot line_--'(�----___.. p� Width of trench----------'------------------ Number of lines ----------Length of me---- �2 Type of filter material_ r-y�.tr�G�Dep filter material------ - -----------Total lengfih_-"--_-___ - --------------------- r i 49 i Seepag it: Distance to nearest well_- � --_----_Di ante from unclation __ ---- __:.Dis�ance to nearesfi lot line______"-_-__ Numk�er?of pits------I---------- --Lining m erial--�-----` ~------Siz Diamet'er-----d�-=-----------Depth__-----3�1----- ----------- Cesspool: Distance from nearest well----------------- istance from foun tion___._-- Lining material-----"_"-_----"---------------- _-- Liquid Capaci#Y--------------------=-------gals. ❑. Size: Diameter----------------------- ---------- ePfh------------- .:, Distance from nearest buildin Privy: Distance from nearest well:---------------------------- --------------- g - P I] Distance to 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 laws, a d rules and regulations of the San Joaquin Local Health District. (Signed) ---------------- ------------ ----------- Vlffu ---___(Owner and/or Contractor) i showing size of l` Title sy:- -------------- �' -------------------------------------------------" --------------------- (Title) . [Plot plan, g lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ----------- APPLICATION ACCEPTED BY Ff DATE • �j�� -- -------------------------------------------------------- " DATE -_-- REVIEWEDBY------------------------------------------- ---- - ---- ----------------------------.----- BUILDING PERMIT ISSUED--------------------- - DATE ---- --------------- I-------'� ------- - --- Alferons and/or rercommenda ion •- ' 'A 14, A PA r ----------- ---- - ------------ U_ --- - • � ----------------------------------------------- FINAL INSPECTION BY---------- -- ----- ------ - --- ----------------- --------- Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 West Oak Street 132 Sycamore Street E14 Tracy, North "C" Street J Lodi, California Manteca, California Tracy, California Stockton, California - ES-9-2M B-51 Revised W-2100