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i� APPLICATION N FOR SANITATION PERMIT Permit No, f ev�y (Complete in Duplicate) ' Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a perm;# to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. . t JOB ADDRESS AND LOCATION______ 3 .Q_1c" t = Owner's-Name-------------' "_ --------------------•-------------------------- ---------------------------- Address,----------------------•-`-- ----- ------ ------ - ------------ Phone Contractor's Name__._______""_• _ •---- - -----------•-----------------•---------•- ►�YYr _ - Installation will serve: Residence,�J Apartment House"House" ----------------- ---- Court--- -•-----------•----------- Phone---------------------------------- �. ❑ Commercial ❑ Trailer Court E] Motel Number of living units: -------- Number of bedrooms .__ __._ ❑ Other ❑ � Number of baths _______ Lot size .____ - Water Supply. Public system ❑ Communit s stem --__? x--- Y Y ❑ Private Depth to Water Table __q$:.ft- Character of sol! to a depth of 3 feet: ,Sand Previous Application Made: yes. ❑ Gravel ❑ Sandy oam ❑ Clay Loam ❑ No New Construction: Yes y ❑ Clay ❑ Adobe Hardpan [] 1)4 N o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) { Septic Tank: -" p Distance from nearest well_-__�-----__`Distance from foun ation__._ _ / No. of com artmenfs... "_- � •------Materiai----- ,�( x 1 c1 y p %� - -.-Size--- X . Al `_�_-_ t --•--- Dis osal Field: f Liquid depth___"__._ Distance from nearest well___ p' Capacity_____" � """"" _ w -�- """_--Distance from foundation_ r � Number of lines----------3 _ -------Distance to nearest lot fine___"" ',_"•" "" Length of each line__?_:._ �Widfh of trench-.---"""-4 �� Type of filter material- - 1� t r -•,�------"_-_--__Depth of fitter material "--"_-" // 9 ------ Seepage Pit: Distance to nearest well_._--_ -- -- ----Total length ]D ---___-__-Distance from foundation___-______-- Distance to nearesf lof-linex�__. _----_--- Number o{ pits___________________•""Lining material______"____" Cess ool: --S;ze: Diameter---------- --------.Depth------- ------ Distance from nearest well-----------------Distance from foundafron____:..._.-""_"- "".Lining material__________ ❑ Size: Diameter------ --------------------Depth--------------------------------- - -------- Priv Liquid Capacity-------.--"- - Y� Distance from nearest well._ --------------------------------------- ---- -------"_ a s. -Distance from nearest 6uildin ❑ Distance to nearest lot line------------- - - - - Remodeling and/or repairing ( ------------•- "--"-describe)______________"," "`"" ---"" ----- ,- -- -----------------•-- --------•-------------------------------------------• -•-- --•---- - ------•-- ----------- --------•----------------------•--•--- -----------------------------------•---------------------- --------- ----------- he i -- •-----•---------------------......•------------------------ ------ I,hereby certify that I have'prepared this application and that the work will b- -Jona in accordance with San Joaquin ordinances, State laws, a rulesand regulations o t n Joaquin local Health District. 9 County (Signed) ------- •--•--• BY: ----•-------•--••-- •---•------•---- . ' + = (Owner and/or Contractor) antractor) (Plot plan, showing size of lot, location of system m relatito ells, buildings, etc., can be placed on reverse side). --- ---------------•--------(Title)--•---- ------------------------------------------------------- on } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --_/ ��------------------------------------ DATE l _._ --- REVIEWED BY-------------------------------- ----- `� BUILDING PERMIT ISSUED ------ "" - ATE------------------••----- -- • -------------------------- -----�----------------- DATE--------•------------ 's erat�ons and/or recommendations:__-. ---•- ----------------------------------- ---------------------------------------------------------------------------------------- y.______-__i_____-_____ _______________ - ________________________ ___-_____--------------------------------------------- .----- --------------------------------------_ ------------------------------------------ JAL- INSPECTION VY w a• � -------------------------- ------- Date--- ----------------------------------------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` t$outh American Street 300 West Oak Scree+ 4ockton, California 132 Sycamore Street 8!4 North "C" Lodi, California Manteca, California Street Tracy. California ' Revised W-2100