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fAPPL)CIN FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date issued ----------------------- This Permit Expires 1 Year From Date issued 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 y&9ounty Ordinance No. 549. (( l��[ll� ------- •---•-- --------------------- JOB ADDRESS AND LOCATION________ -1?7` -: ----------_-�-- Owner s ame______________ --------------------- /7/ ----------------- ------------------------ - - Address = -------••-------------------- -------------------------------------------------------- ------------------------------------------------------ , Phone . - r7L3"" Contractor's Name___ ` "' Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ �Q X Z ----------- Number of living units: ____-_Number of bedrooms ___ _ Number of baths _- __-__ Lot size ------------------------------- Public system F 'Community system ❑ Private ❑ Depth to Water Table ft. Water Supply. Y y Adobe Hardpan C3Character of soil to a depth of 3 feet: Sand ❑ Gravel [I San Loam F1 Clay Loam Ye5❑❑ No F&Previous Application Made: Yes El No a New Construction: Yes j. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if pub' sewer is available within 200 feet.) ( A9-------.M ater'a l- Distant from ti depth y / 191 ------�--- Septic Tank: Distance from nearest well_ _ -� f � 'Liquid de th____�___ _------ -Capacity____, { -------- l No. of compartments � -- ------Size£---- —----------- pj f Disposal Field: Distance from nearest well. Distance from foundatio � =_"----Distance to nearest log line_ --- --- 0 '--_Length of each line------ Q---- -----------Width of trench!------------------------- !f ---.------------------- Number of lines---•---l;Y-140 g �i. Total length -------------- --Depth 1 Type of filter materfal"_,C. ?��'C J- of filter material___-- --- Distance to nearest well------ _ _______________Distance from foundation_ ________________Distanc Seepage Pit: e to nearest lot line----------------- ❑ Number,of'pits----------------------Lining material------------------- -.Size: Diameter---------------- ------Depth_- --- -------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__.__"__-----------Lining 'uid Capacity -gals. ❑ Size: Diameter- -------------------------- ---------Depth--------------------------------------------------- g P Y------------------ -.----- Distance from nearest well_____ __"------------------------- Distance from nearest building____--________________________-_______- , Privy: --- __.� . ._.. . ❑ Distance to nearest lot line---___-_-_---------------------------------------------- ---------------- -- Remodeling and/or repairing (describe =- -----------•----=-----------------------------•------------------------------------------------------- :_�_ ------------------ ------------------------------------------------------------------- --------------------------------------------------=-s-------------=,------------------------ - -.. - ----------------------- tom I hereby certify that I have prepared this'"application and that the work will be done in accordance with San Joaquin County ordinances, State lawsf and rules and regulations of the San Joaquin Local Health District. • --------------- ----------------------(Owner and or Contractor) (Signed) - ��- By: ---- - --- ---- --------- - --- ---------- --- --- - ---------- ---- Title ( ------------- ------------------------------------- 4 (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc.,�can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE---------------- �:� - --------------------------- APPLICATION ACCEPTED BY--------------------- -- �-� " --� -- � ----- - DATE------ -t- ----------------------------------------------- REVIEWED ,,BY---------------------------?------------------- �- `------ DATE---------------- ------------------------------------------ - ---------------- BUILDINGPERMIT ISSUED---------------------------------- -----------------•---------- ----------------- Alteratians and/or recommendations--------- ----------------------------------- ---------- ------------------------ --------- ,� -- -- --- --------- -------- ----- l=1NAL INSPECTION BY: ._.--".__-_._ ----- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stock+on, California Lodi, California r5.9-2M RE,!sed 8-'59�-P.CO-