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; �- 1,�' r1,. APPLICATION FOR SANITATION PERMIT Permit No. _A 7 f- _ A f �p (Complete in Duplicate) "Date €sued __l �__�-- 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 Yo. 549. • JOB ADDRESS AND Owners Name-------------- -- ---- - -----CATI N-------- - ------ ------------- -- ----- - ---- - --------------------------------------------------------------------- ' --- Phone------------------------------------ - ------ ----,- ---- - -------------------- - Address -- 1 --------- ------------- --------------I---------------------------------- Contractor's Nam ------------------------------------ u" - " -- Phone ---------- f Installation will. serve: ,,Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ,, Motel ❑ Other E-]. Number of living units: __j____ Number of bedrooms �-_ Number of baths -1____ Lot size _44---/Swo--------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. ( Character of soil to a-,depth of 3 feet: Sand U," Gravel ❑ Sandy Lo;OPN „,-Clay Loam [_1 Clay ❑ Adobe Hardpan ❑ � f Previous Application Made: .Yes ❑ No New Construction: Yeso ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic`Tanks' ' Distance from nearest well_________________Distance from foundation-------------------- Material--------------------------------------------------- X No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest II_ _.Distance from foundation___ __ ___________ _ _ �� Distance to nearest lot line__ ____________ Number of lines---------- _____A-___Length of each line-----______________ -------Width of trench__,_ Type of fitter material_ __ __Depth of filter material_ _f _________Totai length____ __��__!�_____________________` Seepage Pit: Distance to nearest well------------------------Distance from foundation--------------------Distance to nearest lot line_:___-_____-____ ❑ N&;ber of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material_________________---_________________. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. I „ Distance from-nearest-buildin 'Privy: DistanceYfrom-nearest well____`___---_-"_ - _: �.. � _• -per.. ❑ Distance to nearest lot line-------- --------- ----- --- ----------------•------------------------------------------------------------ ^ ----------------------------------------------- Remodeling and/or repairing (describe):'--"-"_' ” _ __ _ _ _ __1_ -• ------�- -- - �.�- t 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, an rules and regulations of the San Joaquin Local Health District. } (Signed}-------•---------/�[�•j --� - 4j-- ----------------------(Owner and/or Contractor) ) BY:---------------------- --- --�----- ---------------------------------- -----------------(Title)------ ----- -------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on erse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--------------- --- ---------------------------------------:----- DATE--- ------ REVIEWED BY rr --------------------------------- DATE BUILDING PERMIT ISSUED ------------ ------ ------ DATE - Alterationsand/or recommendations-------------------------------------------------------------------------------------------=--------------I------------------------------------------------------ -------------------------------------- --------------------------------------------------------I---------------------------------------------------------------------------------------------------------------------------- = -------•-------------------------------------------------------------------•--------------------------------------------------------------•----------------------------=----------------------------------------------------- ---------------- ----------------------------------------------=---------------------------------------------------------- FINAL --------------------------------------------------------FINAL INSPECTION BY:---- ___ ---/__'-------!L--------------------------------- -Date------------ 'f�__�S'�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street `4 Sfockton; California Lodi, California Manteca, California Tracy, California ES-9-2M 5-51 Revised W-2100 _