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APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) 16 Date Issued AppIicaf_;cpis-h,ereby madejo the San Joaquin Local Health District for a permit to construct and install the work herein described. This appliafi6n4s made�in/compliance with County, Ordi nce No, 549. n'Co�n P"ance with County U rd, nce No, 549 JOB ADDRESS CA - N ....., ...... .. ........ . - -- --------- --- --------------- S D�-OCAPN....... ---77--xt---------------------------------- - ----------------------------------------- Owner's Name: ---- ----- ---------------------------------------------------------------------------------- Phone--------------------------------- ------------- Address-- ------------------ ------- -------- ------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------- Contractor's f - ----------------------- ----------------------------------------------------- Phone----------------------------------- Installation will serve: Residence eApartmenf House E] Commercial 0 Trailer,.Court Q Motel E] Ofh ❑ Number of living units: Number of bedrooms -;� Number of baths --.-/(t`ot�size)-----6jl0--X1 1 TT Wafer Supply: Public system Community system �rc _] Private El Depth to Water Table -------- ft. Character of soil to a depth of'3 feet: Sand [] Gravel E] Sandy Loam; Clay Loam [] Clay E] Adobe �ardpan E] /E] I)i Previous Application Made: Yes E] No New Construction: Yes No El *%li TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Le .. ------to... Septi cTank: Distance from nearest well 440 ---Distance from foundation Mafer aj-jV ----- ---- ----------- No. of compartments------ Liquid depth.----------- --------------Capacity------- --V---0---- 4w'-�-- -Disfance from foundaf* n--------------------Distance to nearest lot I- -------- ---- Distance from nearest ell-' Disposal Field: r El Number of lines___-__-_-- -Length of each line_-__ 0-7�!U-c3-OWidth of trench------I& ��- epfh of filter mafer;aI---'--L;51e -7--- ------ Type of filter maferiad--4-��F�. --------Total length----1.2y-o------------------------- • Seepage Pit: Distance to nearest well----------------------Distance from foundation--_--.-------_---_-.Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from _nearest well-_----------------Distance from foundation------------------ Lining material-----__--__-------_---_-_---________-.-sa Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------- --------gals. yewwe -from,�iea--est4bttiI&n9 Privy: Distance from nearest ----------------------------- ----- --- ------ El Distance to nearest lot line---------------------------------------------- ---- 7 7 &m9fieling and/or rep firing (descri e)�------------ - ------ - ------ -----I-- i- ------------------------------------------------------------------------------------ --------------------------------------------------- --------------------------- ------------------------------------------..........-------------------------- ---------------------------------------------------------------------------------------------------------------•--....------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and: regulations of the San Joaquin Local Health District. (Signedj!� --------- ------------(Owner and/or Contractor) By:------------------------------------------------------------ -------------------- -------------------------(Title)-,, (Plot plan, showing size of [of, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------------ --------------------------------- DATE-��- ,,-,, REVIEWED BY----------- ----------------------------------------------------- DATE----- BUILDING PERMIT ISSUED------- r ----------•--------------------------------------- DATE- Alterations and/or recomr.-tendation ------- ----! �e -----------(;It-J�r--------------- ------ ------------------------- ------------------ s -- ------------ ............ ------------------;---------- -- --------------------------------------- Y 5 c ----------------- ----- --- -- ---- --------------- -- ------------------------------------------------------------------------------------------------------------- -------------- ----------------------------------- ----- -------------------------------------------- --------�11 ---------------------------- ------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ----------------- FINAL INSPECTION BY:-- Dafe- tr- /4 _ 'r_ ------ -------------- /--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M B-SI Revised W-2100