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,1 APPLICATION FOR SANITATION PERMIT Permit No. _..$_ _. Y•--• (Complete in Duplicate) � _Date,lssued ___��!.��5-7 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 County Ordinance No. 549. ' l_._-/lfJ --------•--•• .................................................... cry= ; JOB ADDRESS AND LOCATION__ .. • _ ..._ ................. Phone.............:__._._ --••--•- Owner's Name.:__:/ t'dfZ� _ ..........-- Address. �r�' r 2 r ..._•- _......................:............... Phone--l................. c�c �. Contractors Name...... -___ ..... ._. .. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Number of living units: _.�_._ Number of bedrooms -Number of baths _..�_-Lot size .............. Depth to Water Table dit. Water Supply: Public system ,Community .system ❑ `Private❑ d Gravel SanLoam❑ Clay Loam ❑ Clay❑ Adobe�Hardpan C] - Character of soil to a depth of 3 feet: Sand E] ❑ Y Previous Application Made: Yes ❑ No V.New Construction: Yes Ej_No ❑ - TYPE TOF INSTALLATION AND SPECIFICATIONS: .(No septic tank or_,cesspool permitted if public sewer is available within 200 feet.) Septic T�kr- ❑❑ i from nearest well................Distance from foundation• • Material .Size quid dph- acity_____________ ___.___.__ ompartments------------------------- Disposal -----•--••---•--- -- Disposal Field: istance from nearest well....--•--- .Dafrom foundation....................Distance lot line _Width .:: ::: .. bar of lines.............•--. . ..-- --- ----Length of each line ;Total lengfh.__._.__•••__--_•_----•-••-•••--•-•--•/e of filter material............... -•--Depth•of filter material____.-__-_;,_....., . istance' rom four ation_-�b---••••Distance to nearest lot line____._._ Seepage Pit: Distance to nearest well....[iC � - �_�pe th.__.. •1•�-.`' ••••�........ Number of pits._.---------------Lin ing mater ze: D ameter._.._�.13• -- p ..... .......... m nearest well---________- Distance from foundation__....... Lining material..____:_._.__.._._...___ Cesspool: Distance fth ------------ -•---•••.._.:_....:._.Lquid Capacity-------------•------------ Size: Diameter ...............••--_------ .-.,,.,.,Dep De QC _-------•-,_.:.__._-_Distance from nearest building-------------- ___ Privy: Distance from nearest well.._...........:.'-.___. 4 ❑ Distance to nearest lot line::__________________---_----. ---------•-•--•--••••- Remodeling and/or repairing (describe):----------- -: -- ._....-___•.._......... ........i __•••.•..__...-•••-•--•--...................................... \ ----._____________•_-•- ...................................... - .._.._• - _.....-""............................_._.._._..•-_•-•• -••••••------------...._..-_.................................... .._. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ; and rules and regulations of the San Joaquin Local Health Districf. . �nn S ---___(Ow(Owner and/or Contract �S n d/o (Signed) -••.............. 1 : Title '---------•--------_- ......- By. .. . buildings, ................... - -- e). .(plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plated on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....................._..___•. _.___ = •• -••-••••-..... DATE. -... :-------'••-•:............................._... _. _: •-=--- --.........................REVIEWED BY------------------------------------- �/ :: ' ' :• .............. DATE >�`••--...._..._.._-..-.___...-_....... BUILDING PERMIT ISSUED. -__... - - Alterations and/or recommendations:__....'.'............ ......-1,-- -..- ---••- - ............................................. ----------- ......... ................�7_ ........................... �.--_. --.------z ............... r . - , . . Date....:_E........ .......... _._. FI AL -INSPECTION•BY::::.:__ ................. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 syeamore Street 914 North "C" Street 130 South American S}rest Manteca, California Tracy, California Stockton, California Lodi, California ES-9 14s 6 Arw000 . -