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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Data Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install This application is I made in Compliance with County Ordinance No. 549. 11 the work herein described, JOB ADDRESS AND LOC ON.- �It7 ---------------------------�----/---*--------------C-----."-------------------e-----------------------------------4-----�C------)-r---V----8Owner s Name Address --- ---------------------------------------------------P--h--o--n--e Contractor's Nam ------------------------ Installation will serve: Residence -- ----------------•---------- Phone-----------------------•-- Apartment - ------------------------------------------ --------------- H-ou-se--E]-----Commercial---E]----Trailer Court E] Motel E] ------- --- -- - -- -- -------- ---- -- Number of living units- Z Number of bedrooms -------- ❑ Numbe.r of baths Other Wafer Supply: Public -------- Lot size �Iic system �40mrnunify System E] Priva fe 0 Depth to Water Table3--- -,f-t-------------------------------------------------- Character of soil-,#61' a depth of 3 feet: San 1% Gravel El Sandy Loam 0 Previous,-A;plicaf ion' Made: Yes Ej 0 Cla Loam E] Clay [I Adobe I�T/Hardpan N C New ❑Construction: Yes Ej No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub is sewer is available with' -200 feet.) Septi Tank: I Distance from nearest well Dis'fance?fr f ndafjpn----- No. of compartments...... -----/ateri a I------ de --------61- ---------Capacity-.- Septi permitted if pub with' nearest w wr m r po sal r;It a s e�i n Ci --- sposal Field: Distance from nearest e�i-AhA.'e--Distance rom foundation__-_ -/- ----------Distance to nearest 11o. jV Number m' lines-_-.--- f C 0 each I ---- ------ 4, ongt of each line------- - -------------- ------------ Type OF filter mat ia -------Width of french (,./ Seepage'rPit.- ------ ial-------M44 ---- --- --- -- e t of filter material-,------ ----------Total length------- X/Ct9 Distance to nearesftel � ----------------------- I _Distance from El Number of its i ti ---------------Lining--------------------- foundation_-------_-_.___--- Distance to nearest lot line------..--- Distance i - - - - Lining material---------------- ---- Cesspool: i D, f e f I -------Size. Diameter----------------- -----Depth-_--.----------_-----__ Si7 �om 96'arestiwell-------�Al-I'(----Disfance"frorn foundation-------i()/ ------- -- _e: Diameter--- ----------Depth-------------------- ------ Lining material-_--_----__- 'y. DisfaIrce fro ", Y-----------------------------Liquid Capacity-.--------5ao...... noprest,weli -----------Distance from nearest building--------------------------- ---gals, i i -------I------------------------------ 0 Dl-fbnce to near f I-n s rtet t•lot i e-------------------------------------------------------- ---------- d6scy i ----------------------- - ------------ Remodeling and/ r repairing ------ ------------------- ----------------I-----------------------------I------------------------------------------ It -------------------------------------- ----- ------I- ------------t -----------------------------------------------I------------------------ -----------------------------------------*------------------------------------------ -------------------------------------------------------------------------------------------- --------------- - ------- ------------------------------A ----------- ------ ------------ ---------------------------------------------------- --------------------------------------------------- 6"done in accordance with San Joaquin County I hereby certify that I have prepared this application and that the work will'k� ------------------- ------- ordinances, State- laws. and rules and rpgulaf'ions of the San Joaquin Local Health District. (Signed))(x----------- By:_ ----- -----------------------------------1-------------------------(Owner and/or Contractor) -----------i--------*------ ------------------------I------------------------- (Plot plan. showing::size of lot,-------------*------*--------------------------- -(Title) location of system in relation to wells, buildings, etc„ can be placed on reverse side). FOR, DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______________ ------------------------ ------ --------- --------- ----- --- - ----------------- REVIEWED BY-- ------------------------ ------------------- ----------------------------------------------------------------- DATE BUILDING PERMIT ISSUED -- -------------------- ---------- ------- -DATE-- ------ ----- - ------------------- Alterations and/olreconmencafio-n--s--:-- - -----D--A---T--E----------- ------------------- -------------------------------------------------------------------------------_--'-I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i-:6-��----.-.-.-.-.-.- -------------- f- ------------------- - 4C- --:- ---------- --------- ---------i--t--------------------------------------------------------------- - --------------------- $-;-- --------- ---------------------------------- FINAL ----------------------------------FINAL ---- - - - INSPECTION BY:---------- ------ ---- -------------- ------- Date-. SAN JOAQUIN LOCALfHl ALTH DISTRICT E A 130 South American Street 300 West Oak Street o SfocktonI California 132 Sycamore Sfreef 014 North "C" Street Lod[, California Manteca, California Tracy, California ES-7-2M �0-52 Revised W-21oo