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JW 4 • _f (�` ' .,, APPLICATION FOR SANITATION Permit No. �- ION PERMIT i (Complete in Duplicate) Date Issued Application 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 -OOrdinance N . 549. /.-- _. / JOB ADDRESS AND OCATION---•---- -------- -•-•------------------------------------------------------------ Owner's Name--- ------ Phone----------------------------------- Address------.. --- ---•---------------•-----------------------------------------------•----------------------------------------------------�-------- Contractor's Name--------------- ------ - Phone---�-._ __.atr • --- - ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,---- Number of bedrooms-'�__ Number of baths .-/-__ Lot size _— -_,�- ------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabl-A/Cft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adol ' Hardpan ❑ Previous Application Made: Yes ❑ No.W New Construction: Ye No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f . , _.-.--Materia --- A- - ---------------- ------- rSeptic Tank: Distance from nearest well -__-Distance from foun ati n--- � No. of compartments-__- __.Size. +�� iquicl de pth_r-� -----Capacity--� Q-f Disposal Field- Distance from nearest well 1W from foundation__ — ----_..-.Distance to nearest lo��_.-�_--_--- Number of lines-------- ----------------- --_Length of each kne__�0- --- --- Width of trench_- ---_- __--_---.- --_-- De Depth of filter material--_- _-.- _Total length------ -Q-- --------------------.- Type of filter material- _- -- __ -.-__ p f � ----- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-------.-_---.--. ❑ Number of pits---------------------Lining material-----------------------Size: Diameter------------------ -Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation..------------.--_-.Lining matseial=---.-__--_.---___------.-.--_--_-- ❑ Size: Diameter------------------ -------------------Dept h--------------------- --------------------------,.Liquid Capacity----------------------------gals. Privy: Distance from nearest well--_-_----------- - - ---.--_- ---Distance from nearest building-----_.___---_------------.-----.-._--.-. ❑ Distance to nearest lot line--------- ---- ----------------- ------- --r ------------ -------------------•---------------------------- ------------------------- - --------------- Remodeling and/or repairing {describe}:------ ......... 1�//�----`--- ------------------------------ -----------------------•--------------------------•----- ------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I nd rul an regulations of the San Joaquin Local Health District. (Signed]__----._ -_------(Owner and/or Co actorl -------- --- B By: _------- ' - Title �revese -- 1.-0,(Plot plan, showing size of to , location of system in relation to wells, buildings, etc., can be placed o . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEQ BY-- __ DATE-, , -------------------------------------------------- - tY REVIEWEDBY---------------------- ------- --------------------------- ----------------------------------------------- DATE----rte-- ._-----•---------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE-------- ------------------------------------------ Alterations and/or recommendations:-------------------------------- ---•-----------------------------------------------------------------------------.--------- ---------------------- --------- ----------------------- ----•-------------------------------------------------------- - -- --------------------••---- --- -------------------------------------------------------- r� FINAL INSPECTION BY: r "'- Y date --'-------------- - -------. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M 10-52 Revised W-2100