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APPLICATION FOR'SANITATION PERMIT Permit No. r (Complete in Duplicate) Date Issued l Application is hereby made to the San Joaquin Local Health District for a permit to construct b_:_ � This application is made in compliance with County Ordinance No. 549. ct and install the work herein described. JOB ADDRESS AND LOCATIO I_._ e V e ' . Owner's Name--------•--•---•--•-------•-" - - !1. t-------- Address-•----------------- - ts---------------------- ----- Phone Contractor's Name.___.._._ I ------------------------ ---- -- -- - ----- ---- ---- --- -------- ---- Installation will serve: Residence's Apartment House Phone__________________ ----------------- ' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____._ Number of bedrooms ---- umber of baths __ ___ Lot size _COCA Wafer Supply: / �p PP Y' Public system Community system " ------------- - Priva to p 1 Character of soil to a depth of 3 feet: ' Sand ❑ Depth to Water Table ._______ ft. Previous Application Made: Yes Gravel ❑ Sandy Loam ❑ ClayLoam ❑ Clay ❑ Adobe[ Hardpan ❑ TYPE OF INSTALLATION AND S❑IPECIFIC�ATIONS,ew Construction: Yes TYPE NOXI, (No septic tank or cesspool permitted if public sewer is available with; tic Tank: n 200 feet.) ce from nearest well----------------Distance from foundation--------------- Material--------------- I o compartments_-_-_-_-___-__._ r Size__ I I ;quid depth__. Capacity:--- ------------------ DIV ;. os Field: Distance from nearest well-- -" Distance from foundation_______ � Number o{ lines__-"--•_- ""_ Length of each lino-____-____-�U_�" Distance-fo nearest lot line"" Type of filter materiel-- '__"-- Width of trench. _._..- 4lr_ Y �- ----- epth of filter material /,?Pit: Distance"Jo n arest welh___________ --=-Total length_-_. 1� a -.____Distance from foundation--------------------Distance to nearest lot line_."____.___""- � ❑ Number of pits----- _•-------------Lining material___--- Cess ----- Cesspool ------..Size: Diameter-- Depth p Distance from nearest well-----------------Distance from foundation--------------------Lining material____""- "._ ----------•--- 90 Size: Diameter f f----------------- ------ Depth--------------------------------- - --"------ ---- --- Priv --- ----- ---- -Liquid Capacity-- •---- ----- Y Distance from nearest well--___--_----------------- ------------gals. ` ❑ Distance to nearest lot line_________----------------- Remodeling _________ _ Distance from nearest building"__-__"_" --- ----------- 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 Count ------------------------------------ Y r or lnances„Slate ws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ B . ---------•--•---•--•------••-----•--------” (Owner and/or Contractor) (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 APPLICATION ACCEPTED BY____._____""_ REVIEWEDBY--------------------------------------------- - - ------------------------------- ------ DATE . "-�`=------- BUILDING PERMIT ISSUED----------- --- --- a �` z -----. DATE --------------=------------ =4 ---�-------- • ----------•------------------------------------ A aerations and/or recommendations:-----------"--- DATE__. y -- --- -•- -- --- ------------- --- �-------•------- _ t `—^ �of 2 r ,4�� ------------------- ---------------- FINAL INSPECTION BY--. '/•�/ �` og SAN JOAQUIN LOCAL HEALTH DISTRICT��-�" ' 130 South American Street 300 West Oak Sfreat -- 5fockfon, California 132 Sycamore Sfraef ""gl a / J Lodi, California C" free+ Manteca, California "t -- _ Tree_, Celifnrnie n ES-9-2M 10-52 Revised W-2100