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R Permit -- ---Y � APPLICATION FOR SANITATION PERMIT No.(Complete in Duplicate) Date Issukd /-7/ A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. PP549, This application is made in compliance with County Ordinance No. JOB ADDRESS AND LOCATION------- = "" _ Phone.._- -2-__., f Owner's Name-------------------------------------------- -- -o�_ _ - .- - � -------------------------------------------------------------------------------------------- Address-----------•------------------••----------------.. --. '`'� '-- - --��-- ------•-------••-- - -�- - - --�------ Phone----------------------------------- Contractor's Name--------------------------------- mercial ❑ Trailer Court E] Motel ❑ Other C1Installation will serve: Residence X Apartment House ❑ Com If Number of living units: _-Number of bedrooms -------- Number of baths -------- Lot size ---- Water Supply: Public system, Community s stem Private ❑ Depth to Water Table--- ft. PP y• Y Y ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe. Hardpan ❑ Previous Application Made: Yes E] No, New Construction: Yes E] No [-I�- TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspQal permitted if public sewer is available within 200 feet.)' is Distance from nearest well No. from foundation__________-_______.Material__.-____-____".__-____-______._-__________.\ c -Capacity------------------- --- �,.r-`� No. of compartments---- -------------------Size------•-•-----------------------Liquid depth------------------ p s rld; Distance from nearest well____._--.__-__--Distance from foundation_________-.-------.Distance to nearest lot line_________________ Number oflines-----------------------------------Length of each line--------------- -------------.Width of trench. Type of filter material-------------- I-Depth of filter material________________ -Total length-----------.------------------------------ to --- ------------� ---- -_Distance from jounclation__ --------Distance to nearest lot lin __ Seepage Pit: Distance to nearest well_- _. _ �'--------Dept'n__X_10--------------- Number of pits.._-"� Lining material_ _ _____-Size: Diameter_ ning ' Cesspool: Distance from nearest well________________Distance from foundation------------------""Liquid Ca acit gals. Depth----------------------------- q Capacity ❑ Size: Diameter-------------------------------------- Privy: Distance from nearest well----------------------------------------------.._Distance from nearest building-------------_---------------_----___._._. ---- ❑ Distance to nearest lot line_____________________" --------------------- - ------------ Remodeling and/or repaEnng ( escri a ___________________" - ---------------- - - -- ---------------------•---------------------------- ------------------------ co Sa --- --- ! hereby erti that 1 gave epared this application and that the;work will be done in accordance with San Joaquin County ordinances, S ate l ws, and rules`a d regulations of the San Joaquin Local Health District. q j ontractorj (Signed) Title ate`-`- ----— �- ------ -.- { ' BY: = ------ -- (Plot plan, showing size of loft, location of system relation +o wells, b flings, etc., can be p�ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y_____________________ REVIEWED BY-----------;c------------ ------------------------- ------------------------------ DATE BUILDINGPERMIT ISSUED---- ------------------------------------------------------------- ----------- ------- --------------•---- A1+orations and/or recommendations:._.-___._---------- - ---------------------------------------- ---------------------- V ------- ---- ------------ Date------ 2 -- FINAL INSPECTION BY:-- ---- ----- -- I SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California Fc_4—.?M 10-52 Revised W-2100