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7e A rf)LICATION FOR SANITATION PERMIT Parmit No. ..._: ... .. .. )Complete in Duplicate) Date Issued Applice'ion is hereby made to t:,,• San 1—.]oin Le:al Health Di,trict for o permit to construct and install the work heroin described. This apF•lieation is made• in compliance w ' Co;.nty Ordinance No. 549. JOB ADDRESS Phone z At�iD-bOCATIOtl 2 % �,.�t.i l!✓C�. / nme ..rf '' Owner's N .�.. .Gr!. le, -1- .. . . ..� :• - Address.�, �...�.................. Contractor's Nome. . .. �'(..- fir y�c.. _ .... Phone.. ..a;- ..`... ... Installation will serve: Residence Apartment House ❑ Commercial [] Trailor Court ❑ Motel 0 Other C] Number of livin.3 units: Number ccf bedrooms . Number of baths / Lot size -.:;-e1l` . _ �j... .. ..... •... Water Supply: Pubiic system" Community system ❑ Private ❑ Depth to Water Tabloe.2 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ N., New Construction: Yes ' No ❑ / \\ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from neire;i well . ...... ......Disience from foundation................Material........... ... -.............I......_.. -� a No. of compart,nenlr. Size................. .............Liquid depth .. ..... . .. .... . Capacity...... ......... . ... L/'�,L, • Disposal Fi Distance f om nearesf wr,;I -02P Distance lrom foundation. ./Cl �. Distance to nearest lot line....✓.......... Number of lines. f. �/ Length of each line......,3♦ Width of trencltir� �........jle" Type of filter materiel�t�'t y(f....Depth of filter material.. � .��. . . Total Iength..f.... .�... Q.. Seepage Pit: Distance to nearest we!I _.. ... .._Distance from foundation...................Distance to neefist4o+4irRr. ... .......✓.. ❑ Number of pits _ Lining material.......... _.. _ Size: Diameter.. ......... Depth ' Cesspool: Distance from r-arest well... .... .. -Distance from foundation Lining material O Size: Diameter ._Depth. -._.. ..._........... .. _ Liquid Capacity. ... __. . ...gals. } Privy: Distance from nearest s•:ell .......Distance from nearest building..... ! F1 Distance to nearest lot line .......... ......... .......I . emodeling and/or r airing (describe): Gl... � ..._ ._ �aG.... .... ..� y ....... ..................... ................................................... _....... ..-... . a.................................. ... _. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and les pnd regulati of th') San Joaquin Local Health District. (Signed) �. owner r Contractor) 9 ).......... ..... '....... ................................... ...... ............ By.................... .. :.r.` .......... .................. ........ ..,............. ..... ............... .....�T'itb). Zsid, ;Plot plan, showing size of lot, locatinn of system in relation to wells, buildings, eta, can be p on reve FOR DEPARTMENT USE ONLY ---------- - APPLICATION ACCEPTED BY.. _. .__. ......_.................. .......... DATE................. ...r _ .:.r ..... DATE..........1.1_.' ..w................... REVIEWED BY..... . ..._. _ .:.'- .. ._ ... .. _._...... ... .......'............................ BUILDING PERMIT ISSUED.... .. _ ...... .... _.. ........ . ................ DATE............................ . . ... ..... Alterations and/or recommendations: .. . .. ....... ..............................-.................................._........................................-.. .. .... ..... t................. . _........... .................... ...... .. .. FINAL INSPECTIC l BY: �~ '. .... ... Date_ � .�./ �. ................................ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amer;cen Street 300 weir Oak Street 132 Sycamore Street 814 North "C' Street Sfockton. Celffornia I.odf, CaCfornia Man/eu, CaVornis Tracy. California ES-9-2M Rov;%od W.2100