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i -- a�rr..-•--� �� a �-� APPLICATION FOR SANITATION PERMIT Permit No. ...../1-, • (Complete in Duplicate) ,� This Permit Expires Z Year From Date Issued ,A Date Issued J1/C/_ 1_a 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 o. 5. 49. JOB ADDRESS AND LOCATION.---------____ ova . -- ".__ ------------------------ Owner's Name______ _ ---------------------------- Phone-)-/()-- Address s_ 3� ------ ---- ontractor's Name_________________ --.---- = Phone. Installation will serve: Residence Apartment House [] Commercial ElTrailer Court 0Motel ❑ Other Number of living units: __ Number of bedrooms __QC- Number of baths _ Lot-size �,/ ❑ - -- _-"_."�tJ-- Water Supply: Public system Community system ❑ `""""•---------- Private ❑ Depth to Water Tablet Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes EY No ❑ New Construction: Yes Fr-No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well �� No. from foundation_______________"___.Material_._______._.___.__._ No. of compartments----_-__ ----------------------------- Size Liquid depth Capacity Disposal Field: Distance from nearest well.._--------------Distance from foundation--------------- Distance to nearest lot line__________._____ Number of lines______—-------------------------Length of each line___.-____._._ Type of filter'material----•------------- ---""" Depth of filter material---------------------I.Width of trench----------------------------------- length------------------------------------------ Seepage Pit: Distance to nearest well------_---------------Distance from foundation---.________ _fl Distance to nearest lot line__.__._"__.______ Number of pit;___------------------Lining material""- --- Size: Diameter-----------------------Depth------------------------ d Cesspool: Distance from nearest well---- -:.,:."_Distance from foundation"__.-.____""._--"--.'Lining material_______________�__--_. Size: Diameter-_1 ----------- ---"--- -Depth-------- ----------•------------------ - - I --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__. ❑ Distance to nearest lot line._._ _" .__ --------------------------Distance from nearest building-- ----------------------------- ----------- .--------- ----- 1- -r`: Remo eling an or repairin d scribe :. gf 7 ---------- '__ ---�_ --- --- ---- -------- �-------------------------------------------------------------------------------- ------------------------------------=--------------------------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, and rules and regulations of the San Joaquin.Local Health District, (Signed) =: - BY: y-' __ a ------ (Owner and/or Contractor) le { p g• g -- - -side) -- - P o f+ Ian, showin size of lot, location of system in relation to wells, 6uildin s, etc., can be placed on reverse side}. t A FOR DEPARTMENT UE-ONLY APPLICATION ACCEPTED BY_.__ ------- ' --- DATE s _ C?_ EJB REVIEWED BY t '1 ► F ------------------- ----------------------------- ---------- --------------- } DATE BUILDING PERMIT ISSUED --------------------------------5tI t` z )_ t' '� . 0 ------------------------------•- - -------- — t ----------- DA•TE. Alterations and/or recommendations:_._'----------___ `""�`� ° ' # ---------------- ------------ ` _.__..".j__-_._ _._____" 4--- ---�� .._-.v= . .c _______________ ---------------- "F._..F-_r-.____-_ _ --------=-------------------- ------------------------------ --------- - ---------------------- 'FINAL INSPECTION _ �-'tom " __ -Date---- - == (`'- --------- --- ' SAN'JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street " ` ' 4 g 300 West Oak Street 132 Sycamore Street Stocktar,, California "" ;"" 814 North "C" Street Lodi, California. Manteca, California Tracy. Cnlifoenia . . ES-9-2M Revised 8-'$9 F.P.Co. - I :