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�—. - Permit No. __�.�-�-�•- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ✓ -�-} •f Applica ion 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 CountyOrdin nce No. 549.t r JOB ADDRESS AND LOCATION . _-_ - - . E :_. Owner's Name f i - `��1 _7.4_ �s�.-��-^ P� � �_�_-_-�1- Phone--------------------------------- Address r- � v — Pone - -----•--- --------- ............................ Contractor's Name Commercial ❑ Trailer Court ❑ Motel ❑..o ,�'b Installation will serve: Residence`j Apartment House ❑ ter-' _ ----------- Number of living units: ----I--- Number of bedrooms - Number of baths ._-; -- Lot size ., Private Depth to Water Table 7 _r_ ft.6 Water Supply: Public system ❑ Community system ❑ �� p �.} Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� Hardpan ❑ Previous Application Made: Yes C] No ] New Construction: Yes ��No ElFHA/VA: Yes ❑ No rC , TYPE OF INSTALLATION AND SPECIFICATIONS: \ No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r _,. - - ( . p _... �-. . /, I` 1� c Septi Tank: Distance from nearest well-----------------Distance from found ao:r_-.___,_.�`----Materia.-_-___-_ ------------------------- --------.--------� -Size- --, -- - P 4... apacity--- -C - No. of compartments-.. ------------- -- �`urd de th--____-- Distance from foundation-_ ".- .Distance to nearest lot line Disposal Field: Distance from nearest well__-+�-__--__-_-. � 9A��6Width of french------2__ -----------•--- Number of lines_______---------------------------Length of each line---___-_-- /1 --Total length f -�---------------- Type of filter material- n--Depth of filter material-_ _-__-- -_- 9 Seepage Pit: Distance to nearest well---------------------Distance from foundation ------------------ t-- nearest lot line__----__-_.__-. Number of pits----- ----------------Lining material-----------------------Size: Diameter---- Depth. - L. ❑ ------- ------------ Cesspool: - ----- Cesspool: Distance from nearest well-----------------Distance from foundation___ _____________-Lining material--.-.___-- gals. ❑ Size: Diameter ---------------Depth-------------------------------------------------- Liquid Capacity--_-----------------' g T- . L.�r I : _ . _ "S _ ----------- ,. .�. - Privy' _--____.-____ --�-_._Distance from nearest building----------------_-_-__ ' Distance from nearest we __-------_ ❑ - . . _ - - - Distance to nearest lot-line -------'- ------------ --------------------------------- repairing --•-----------•=--- -----------------------------------•-------------------•----=------ ------ Remodeling and/or repairing {describe):--_ - r - ---•--------•----- ------ J I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun y ordinances, State laws, and rules. and' regulations of the San Joaquin Local Health District. r - nT t) ---- ------- {Owner and/or Contractor) or) Tale By-----------------------•--------------------•---- ----•, ----- (Plot plan, showing size of lof, locatian'of system rin.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- ----- ----------------------------------- ----- DATE_. - - --- -- ----------------- APPLICATION - ' - � �--'-"- ;"r"�---- --. -------------------------- DATE-------�-�----------f-- "�-`--- -------------- REVIEWED BY------------------------ ' —� --------------------------------------- - �---�-C�-��''-`� - ----------------- --------- DATE------------------------------------------- --- BUILDING PERMIT IS5UED------------------------------------- ;, =` Alterations and/or recommendations:__-_--_--_------------- -- --- ----------------- ---=------- ----------------------------•----------------------- ------------- --------------- ----- ------------- -----•------ - ------- --------- ---------- ----- ----------- FINAL INSPECTION BY---------- ---------- --------- - Date----------------•- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 30o West Oak Street 132 Sycamore Street 914 Norfh " Street 13o South American Street Tracy, Caiifarnia Stockfon, California - Lodi, California Manteca, California ES-9-2M - Revised 1.57 F.p.Co.