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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _---./_!� - Applica-•ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereindebee� This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS AND LOC TION____" ----f� --- - � d.r ---- Phone. .. . : ' Owner's Name--------- _- r Address. -- - ZSA---------- -- Z L - Contractor's Name"_/ --'��'•---•------------•----••------------- -------- ----------•- ---- - ---- Installation will serve: Residence,4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other [3 off' 1 G-r l_�'-,4"� Number of living units: J------ Number of bedrooms . _._ Number of baths I"""- Lot size ____"t�"-------- ------•---------- Water Supply: Public system ❑ Community system ❑ Private M Depth to Wafter Table . ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No M 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 nearest well-----------------Distance from foundation---------------- ---- Material_"""--_"._--__.- ❑ No. of compartments------ ---- -------- ---Size--------------------------------Liquid depth----------_--- ----------Capacity------------------ Disposal Field: Distance from nearest well_" 0__"._-_Distance from foundation--_�-P.'.__....Distance to nearest lot line_"__ _ Number of lines.- ------ --- Length of each line----- 4_b--------------------Width of french-----�'y�-------------------- Type of filter material"_"�y� l-_----Depth of filter material__--14-_.-__----Total length--___--"��-�------------------------ (�1 Seepage Pit: Distance to nearest well..............._-.---Distance from foundation_---..--_.-.---._--.Distance to nearest lot line_----- -----_ IN ❑ Size: Diameter Number of`pits-------------------- -Lining material-•----.--------__ --.. -_...----------- Deptn---------- - ---- Cesspool: -Distance-from nearest well-------- from foundation--------------------Lining material__.--------------------- •---als. ` >De th --Liquid Capacity------------•--------•------9 ❑ --- Size: Diameter------ ---------------------- ---- p Privy: Distance from nearest well--------------------------------------"------ ---Distance from nearest building------------------------------- ❑ Distance to nearest lot line--------.----------- }-� " Remodeling anti/or repairing (describe):" ---- --- ------------ == ----------------------------- = ------------ - - ------------------------------------prepared PP al Health District. I hereby certify that I have this a application and that the-work will be done in accordance with San Joaquin County ordinances.�Ile laws, rules and regulations of the San Joa uin Loc* ----------------------------------- -------------- •---------- -------(Owner and/or Contractor) (Signed).---- -- (Titl ....... - By:------- - :-_ ------=:- - -------------------- - (Plo+ plan, showing size of lot, location of system in relation to wefts,"buildings,etc.,-can be placed on reverse side]. FOR DEPARTMENT USE ONLY- APPLICATION ACCEPTED BY..-_ . -_-- ----- - -- - - DATE__/----�--/7 `f-------------------------------- REVIEWEDBY---------------------------------------------- ------------ ------------------------------- -- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------ DATE ----------•---------------------------------- --------------- Alterations and/or recommendations----------- -------...................... ------------ ----- - - •--- ------------------------------------------------------------ ""` FINAL INSPECTION BY:-_ -------- -- Y - Date..:. .�. - ------------------ -------------------- --`"`SAWJOAQUIN-LOCAL HEALTH DISTRICTT. ='� _ 814 North "C" Street } r 132 Sycamore Street 130 5outh'Ameriean Street 300 Wast Oak Street �-- y t r - � Lodi, California Manteca, California ,' Tracy. California i +on, California r