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__ L ��0 Permit No.��/--------- APPLICATION FOR SANITATION PERMIT , (Complete in Duplicate) Date Issued"" '-1 ------'+` i � Applica+ion 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 O inance o. 549. s , JOB ADDRESS AND#�_AVTIO _..____. ___ ------------------------- ---- �� ------ ------ ..T______________Owner s Name___.______ . ------------------------------------•----------------"----------- Address--- --- - --•--- ----- Contractor's Name-------- ---•---------- ---- -- �-- ----•--- ----- Installation will serve: Residence/___Lld' Apartment House C] Commercial E] Trailer Court ❑ Number of living units: __- Mo#el ❑ Other ❑ Number of bedrooms �-- Number of baths --- ---- Lot size __.�--�-��-a•-----------------•-------------- Water Supply: Public system Community system C]El ❑ Depth to Water Table "t" Character of soil p ft• to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F-1 Clay Loam El Clay ❑ Adobe�ardpan E] Previous Application Made: Yes ❑ No O New Constructio : es ❑ No �� { TYPE OF INSTALLATION AND SPECIFICATIONS: 'lJ� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + Distance from nearest well_________________Distance from foundation____________.____-_.Material__""__._______-._____.___.________---------"" -- Septic Tan : Size--------------------------------Liquid depth--------------------------Capacity----------------------- ❑ { N . of compartments-------------------------- Disposal Field: Distance from nearest well___-- Distance from foundation________"_______.-_.Dis#ante to nearest lot ine.._________.___. Len th of each line------------------------------Width of trench----------------------------- ----- ❑ Number of lines- ---------------------------- 9 Type of filter material-------------------------Depth of filter material_--..---------------�-Total length-------------------•----- �... 4n dDistance to nearest lot line____--....-- Seepag Pit: Distance to nearest well_:___.___-f- -"--Distance fro fou afiian__=._1.-_- ----� 3 a-""" Depth"" a--------------------- Seepa Size: Diameter.___ Number of pits-----.__i_____________Linmg material�_e--- -- - - Cesspool: Distance from nearest we4l________________ Distance from foundation-----.____.._-_.__.Lining material_.__..____________.______.______.__. . _Li uid Ca acit gals. ❑ size. Diameter- ------- -------- ---- --- -------Depth------- ---------------- -------- -------- ------ q Capacity -----------------•--- ! Distance from nearest buildin Privy: Distance from -nearest yell---------________t--___------- I ❑ -. � Distance to nearest lotine__ ---------=-------------------------------I- - --------- -----------------------••------•-------------•--=...... t Remodeling and/or repairing (describe);------------------------------------------------------------------- • ' ----------------------------------------•------ ---------- ---------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I nd rules and regulatio of the San Joaquin Local Health District. ----------(ftIwer and/or Contractor) Sined ...............-- -- ------------------- -------- (Title)----- ---- - p (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side]. FOR DEPARTMENT USE ONLY ,r DATE-------------- --r 7`�v- -------- APPLICATION ACCEPTED BY------------------------------------------------- t/ "� Q - REVIEWED BY------------------------------------ ----------------------------------- -------- ---- DATE----------------------------•-------•----------------------- ----------------------------- • BUILDING PERMIT ISSUED--------------------------------------------------------- ------------------------ -------- ---------- - • ----------------------------------------------------------------- Alterations and/or recommendations:___----------------------------------------- -------------------------------------------- ---- - -------- - V_ ` Date------------ ---------- --------- ------------------------- FINAL INSPECTION BY---------=------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 30D West Oak Street 132 Sycamore Street 814 North "C" Street !30 South n. Califo Street Manteca, California Tracy, California Stockton. California � Lodi, California i