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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued k Application is hereby made fo the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No.'544 herein described. e JOB ADDRESS AND L CA ION --- -- -- --- Owner's Name- .---- t- -- ---- -- ------------------ -------- -------- Phone-----•----------------- -- --- ----- r. Address-------- ------•--- - - ---•-----•-- ----- ----•- -------------•--r---------- ------------------------------------------- Contractor's Name__ __ ------ -- - rF Installation will serve: Residence Apartment House--❑---Commercial- - ----------- ---•---------- --- -----•------ Phone ----------------�- ❑ Trail Curt ❑ Motelr❑ Other ❑ r-- Number of living units: / Number of bedrooms _ p �. �- Number of baths �:_� Lot size __I�o�._� � C7 D Water Supply: Public system ❑ -Communitys stem r --------------------------- i Y ❑ Private Dep}h to Water Table __-___-- ft. Character of soil to a depth of 3 fee}: Sand Gravel E] Sandy Loam . Clay Loam ❑ Clay ElAdobe [91"Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes L' No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I t Septic nk: Distance from nearest well --___Distance fr m foundationT_r__�Q. r No. of compartments_.__...; Ma#erial-- / 14 ----------Size------ x- Liquid depth_-. ' err Capacity d. p sa.l Field: Distance from nearest well Number from foundation_ �d ,__. _.__.Distance to nearest lot line-___-_ .._Y " is Number of lines_:___- ------_---Length of each line______-_ 0_-.----- ..... .Width of trench. �— '/' Type of filter meteriai-_ - Depth of filter material.-_--.'� __�-_._--.Total length----------------- / Seepage Pit: � Distance #o nearest well_----------------------Distance from foundation-------------_------Distance to nearest lot line __._________. ❑ Number of Pits.--I------------------Lining material-----------------------Size: Diameter__.._______._ fDepth----------------------------•---- `d Cesspool: Distance from nearest well________________ Distance from foundation._.__---------------Lining material__-_.--__- ❑ Size: Diameter-- Depth '= Liquid Capacity gals. `!, l ------- rivy: Distance from nearest well__.__---_---------------- --- - _ _Distance from nearest building ❑ Distance to nearest lot line_----_-- } .--_ Ott. -�---•-- I ------------ -------=------f R odeg std/or r pairing_( e cn eJ---- -- -- --- ------- ---- # } ---- --- :::::::::::::::::::::::::::::: ::::::::::: _ ---- -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County r I ordinances, Sta a laws, and rules and! egulations f tete San Joaquin Local Health District. (Signed)- ----------------------- ------------------ -----(Owner and/or Contractor) Y= --•------ - } -----------------------------•-------------- - -------(Title)---------------------------------- -----------------�« (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U_SE ONLY ,l APPLICATION ACCEPTED BY--------- REVIEWED BY •- --- -_-- -- ----------------------------------- ------=------------------ DATE---------- _ i BUILDING PERMIT ISSUED--------- _ = ----- ------- ------------ DATE---------- �. -- -------------- •--------- --------- ----.--- DATE--------------------------- Alterations and/or recommendations:_--=-�-- - •----- --- -------- ---------- ----=-------- �,---- ------ ----------------•- - ---------------------------------- -------------------------------- FINAL INSPECTION BY:-. ------ ------------ Date.. I! _ .{-.` __i- ; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 W40..Oak Street 132 Sycamore Street Stoektort, California 814 North "C" Street Lodi, California Manteca, California Tracy, California Es-9 145446 ATWOCD