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� '. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 l� � Date Issued ___-- _ -- ApplicaDs 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 No. 549, JOB ADDRESS AND --- _-- ---------------------•- .. - =--------------------------------------- --AddOwner's Name-- f��GI �....---------- j e ' 1Z .l'1- e ----------------------------------------- -- Phone--- Address------------------ ress------------------ ---"6i--��'I--�------------•-- � Contractor's Name Phone_.. Installation will serve: Residence 9( Apartment House [ICommercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms „3-- Number of baths ----I Lot size -__ If- ---------- Water Supply: public .system-Z Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: 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 net wen L___'y_Dista romp foundion_--� _. No. of compartments s P o`�-----------------Size_-�`-�-�_1�.�__..Liquid depth---� ----- --------------Capacity--- --�--Q---- .Disposal Field- Distance from nearest weft_________________Distance from foundation____ ____._..-_.Distance to nearest lot line_ �] Number of lines-------------/ -___--- Length of each line_.____�_p�7O_`r_-_-.--Width of trench.__ �� . �--r+l-- -------------------- Type of filter material____ �y .----Depth of filter material___AP---------•--Total length------- Seepage Pit: Distance to nearest well_ .__ ---__ Distance from fou dation___:5_ZT.........Distanc!Vo nearest lot line__j----------- /a f Number of pits..- ------_-- Li ung material .Size: Diameter__._ ._ZXjfDe tn____-. - Cesspool: Distance from nearest well_________________Distance from foundation_____.--______-____.Lining material------------------------------------- El _-_______-_--_.._._______-------_❑ Size: Diameter------------------ -------------------Depth--- ------------------------------------------------Liquid Capacity_....- gals. Privy: Distance from nearest well__..______________________ ___---Distance from nearest building r --- g----------------------- ❑ Distance to nearest lot line ------------- --- /---------------------------- ---•-----------,------------- / ----------- z ' Remodeling and/or repairing (describe):----------------- ----------------------- -=-------- ----= --------- ---•-••--------•---------------•-----------=•---- =------- ..__..._ ------------------------------------------------------•----------------•------•--------•-•----•------------------------- •------------------------------------- --•--••------- ----------------------- P reby rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordina laws, and rules and lations of the San Joaquin Local Health District. (Signed = 1112irr ------ -------------(Owner and/or Contractor) By------- --- ----•------------------•-- --------- ••-•----------------- Title - - ---------------------- -(Plot plan, ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --------•--- �_ _ DATE--..----_ .. �REVIEWED BY---------------•-- - --- - - ------ ------ DATE_..._- r - BUILDING PERMIT ISSUED----------------- -- --- DATE-- Alterations --- -----------------------------• --------------•-- ------------------------------------------- Alterations and/or.recommendations:�._-.-.._ �. _ -_ r ---•-•x -•�°�`------Tom'-u--�Z =-�-vyf-i ' -- --- - --f Jr"�`.-- ------ --- .. ..----- •--- - - - ----------- - •- ---•• ----- -• -• --- ------ - - - -- - id Ayr ------------------ �I FINAL INSPECTION BY:------IF ---- -•--• - --- ----•----- Date- --- ! SCAN JJ�O l7 OCAL HEALTH DISTRICT 130 ck6 American S}rest 300 Wes} pe Street') 132 Sycamore Street 814 Norfh "C" Sfrea+ ockfon, California Lodi, Calif nie /Jr Manteca, California Tracy. California ES-4-21v1 l Revised W-2100 w ',