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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date- Issued ica Appltion is-hereby made to,the San Joaquin-Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. CATI - - _s _' ------------- -------•----------------------- JOB ADDRESS AN D `• A Owner's Name--------- T ------------------------------------------- Phone_., _ Address --- ------- - '- Phone .-,� ...- Contractor's Name____ i x Installation will serve:_ Residence Apartment ouse ❑ Commercial ❑ Trailer Court-[I Motel ❑ Other ❑ Number of living units: _I-_- Number of bedrooms _aX- Number of baths _/__.'LOt size . -------------------- Water.Supply: Public ,system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam E] Clay Loam F] Clay ❑ Adobe ' Hardpan ❑ -Previous Application Made: Yes ❑ No New Construction: Ye No F]TY PE��bF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_��--- Distance fro foundation__ 4_..___..Ma final __i '-------------------- �.• No. of compartments...... ............Size- ,�' Liquid _--_Capacity._..-- ti Distance from foundation --- -------r--_-..Distance to nearest lot line.__.. Disposal Field: Distance,from nearest well-�j�:___. / " Number of lines--------/-----------------------Length of each line------------------------------Width of trench-- Type of filter material-------------------------Depth of filter material-----------------------Total length-------- ___ - -See age Pit: 'Distance to net es#well_. _ _ _--- ' Dist �e f m ou ation---Ill✓'------Distance to e`arest�ot line.-..- inin matrtl- $i lame 3� ep .x um er f—lai#s g � � = Cesspool: Distance from nearest well----------------- Size: from foundation______________ tirug materiel---------------------------------___. ❑ Size: Diameter---------------------------------r----Depth------------------------------------------- --------Liquid Capacity-------- -------------------gals. -- _-.-Distance from nearesi-buildin , Privy: Dist�ince from nearest wail------------- -------------- --- ---- g ----------------------------------------� - �a Distance to nearest lot line------ - ------------------------------------------------------------- ------------ --------------------------------- ---t------------------ 3 ,n -- ----------------�- 4 --------k------ edEeli g a /or.repair g (descril7e�: � ------------------------ _Z 1/ �'� C� -Z---• - ----- C � �J --- ---- ------ -------- ------- -------- �_ ----- w `F I hereby cert' that l have prepared this app rication and t at th work will be done in accordance with San Joaquin County ordinances, Stat aws, an r and regula#i ns of,.the San Joaquin Local Health District. I ..-------{Owner and/ r Contractorl (Signed ------------------ ------ ----------------------- Tale Sy:----------- - ----�� ----------------• -------------------------- (Plot ------------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can e p aced on reverse side FOR DEPARTMENT USE ONLY " �,, . . DATE APPLICATION ACCEPTED BY --- - __,..,,,. TE REVIEWED BY------- ---y -,. a DA BUILDING PERMIT ISSUED.. -'- ---- �. ------------- DATE - --- Alterations and/or recommendati ns--------- --------------•------•---------•----•-------------•-•-----------------•---------------------- ----------------------------------- ----------- ----------------------------------------------- ---t------ ;0 � ------ ------------/---------- --__-------- -------- ----- --- -- -- - -------------------------- -------------------------------------------------------- ---------------------------------------------7 `1--------4 ------V------.-x44 . -- - — ------ ''" ---- -- --------- - ��r ---------------- ------------------------ f - FINAL INSPECTION BY:_: -------------------------------- Date-------- 1 1 _4----------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American $tree+ 300 Wast Oak Street SManteca, CaliforniaTracy, California Stockton, California Lodi, California ES-9-2M ; itevised W2100 r