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` Permit No. __ .._!--------------- (Complete G_ ._ APPLICATION FOR SANITATION` PERMIT -- (Complete in Duplicate) �3 St Date Issued ---- __.r-------- 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 incompliance with County Ordinance No. 549. JOB ADDRESS-AND LOC TION_ _ jt_ �_Y.A-----r. __�.- .- -.--- Owner s Name :.. 'r r ---- � -- -------------•--- ------ I'hone. -------- _ :. Address _-------------------... '----------------------•------------------ -------------------------------------------------------- Contractor's Name ------- ---------------- • -f Phone. �- Installation will "serve: Residen-e 8 Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofgl ❑ Otherl❑ __ t Number of living units: --__ Number of bedrooms _ -I__- Number of,baths k... Lot size __. �-.Z_. /�---------------------- Water Supply: Public system ❑ Community system ❑ Private ❑v,Depth to Water Table -------- ff. Character of soil to a depth of 3 feet: Sand ❑ -Gravel [],.,Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9--Hardpan ❑`r .) Previous Application Made: Yes ❑ No V New Construction: Yes [0100"No ❑ �^ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seweq,is available within 200 feet.) Septic ank: Distance from nearest wel �• _ Distance from foundation_ a '4��M�ateriaL___ �_'_ No. of compartments �d �s '_�'��S,,iz�e Liquid ep. CapacitY _ .. e s Distance from foundation_10_-stance to nearest lot line__ __.____. l Dispos Field: Distance-from nearest well .._ Number of lines------ C-- g i L_-. Total hlen length nch` , -,.Length th of each line_____________ � � � Type of filter materra_ _ -.. .-_ -,-Depth of filter mater a g IL .. ,� `• �- I Seeps Pit: Distance to nearest \jII709.-------------Distant o f•oun atiory_-_ .. -.___ ._.;.Distant# to nearest lot line______._____ Number of p ! g _: S4e:-Diameter----- ! --------Depth---------- Cess.pool: Distance fromnearestwell- Linin mDistance from foundation-------------------lining material-----------------------------.__-----. ❑ Size: Diameter------------------- Depth----------------------------------------- ---------Liquid CapacitY----•----------------------gals. Privy:' Distance from nearest well------------------- --------------------------distance from nearest building-------------.---------------------.-----. ""' Distance to nearest lot line------------- --- - a � e . Remodelingand/or repairing (describe)----------------- ---- ------------------------•--------------•--------------:--------------- ------------------------------------------------------- q ------------------Y ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------ -- I hereby cert' at have prepared this applicat' n and that the work will be done in accordance with San Joaquin County ord'+nances, Stat la s •a rules and re tions of San Joaquin Local Health District. -- ---------- -- ------ -- --------- ------------------ ------------ ----- - (Owner and/or Contractor) (Signed)... BYL---------------------- • -------------• ---------- -----_--------- ---- ------------------------------------------------------(Title)---------------- ------ ------------------------------ ---- -- (Plot plan, showing size of lot, I cation of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :.__... DATE REVIEWED BY--------•-------=-.- ----------- -- -- - --- - -------- ---------- = ----------•----------=-- ----------------------• .. DATE-_%-. ----------------------------- BUILDING PERMIT ISSUED---------- DATE-._ _ ----------------- ------------------------------------------------------------------ Alterationsand/or recommendations----------- --------------------------- ----------------•----------------------------------------------------------------------------------------------------- --- ------------ --•---------------•------------------•-•------------------------------ - ------------- ----------- ---------------- --- -- " -------- ----1��_ = •�. Q -•--•------- -----------------------------------------------•------------------ -- FINAL INSPECTION, BY-------------- - ----------- --- ------------------ ----------- `5 Date - � ' SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 South American Street 300 West Oak Stree+ ` 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy. California ES'--5 145446 ATWOOD