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Llc�� l _ `, G16 Permit No. -- ----- - --- 2J 1 APPLICATION FOR SANITATION PERMIT= 3� I {Complete in Duplicated Date Issued ----- ?V �_ tv AJY Application is hereby made to the San-Joaq`uuiin Local Health District for a permit to construct and in all the r h ein described This application is made in compliance with County Ordinance No. 549. �f { •cl ` I JOB ADDRESS AND LOCATION._ --- --- -- --- - --"'-- Owner's Name__..__1- - - ��'n,----------------•-------•-----------•-------------------- ---- ------------------------------------ - Phone----- Address.----------- ---Address.----------- � ------------------------••-------------------------------------•---------------- Contractor's Name--------------------------- Phone..----•--------------------------- ------ ------------- Installation will serve: 1Zesidence Apartmgpt House E] Commercial [-] Trailer Court F] Motel LlOther ❑ Number of living units: _�_____ Num er of bedrooms .-- { Number of baths Lot size ---------- ------------------------------------------------- Water Supply: Public system ❑ Community system ❑ PrivateM, Depth to Water Table 1 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA 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.) i Septic Tank: Distance from nearest well----I---Distance from foundation___ -A__-------.Mate rial--------------- ------------------------ T No. of com artments-- ------------------------Size___ .Xs _X-_�- - Liquid depth --- Capacity---P�'C 49-----_-Distance to nearest lot lin�__�_Disposal Field: Distance from nearest well__._�l�--.._Distance from foundation______ - Number of lines___-__-.-_�� .__------ --------Length of each line______6_en__.____-____.Width of trench__-- f_De th of filter material__-t?- ------------Total len th-__�r -Type of filter material___ _ p - g Seepage Pit: Distance to nearest well______________________Distance from foundation___.________-___--. Distance to nearest lot line----___-____❑ Number of pits----------------------Lining material-------'.---""'__----Size:'Diaineter-----------------------Depth---------------------------Cesspool, Distance from nearest well-----------------Distance from foundation---------------------Lining material______________________________-_-___ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------- --------------------------Distance from nearest building---------------------------------. ------- ❑ Distance to nearest lot line------------------------ --------------------- -----------------------------------------------------•------------ --------------------- ----- 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 County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a Si ned ----- - ----------- ------------------ -----------------------------=------------------------(Owne an /or tractor) ( g } r Con g `�..LJ� tt�t { + '---------------------- (Title k Y� �, oi4lo Ian showing ocation of system iii relation to wells, buildings, etc., can be place on reverse side). (Plot p h A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------------- ---------------------------- DATE----- r 5 ---------------------- DATE--------- --------- REVIEWED BY------------------•------------------------. -----_-------------------------------------------------------------- ----------- BUILDINGPERMIT ISSUED----------------------------------- ----------------------------------------•---- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------I------------------ -----=------------------------------- -----------------------------------•--------------------------- -------------- ------------ L � �Y/�---------- ` ' --------cam ---•---•---��---------- - f�'�------ ---------------- � ----- --------------------------------------- ----- ------------- ----------------------------------------------- ---- FINAL INSPECTION BY: '` -------i�-----�--------- ---------- = Date .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100