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APPLICATION FOR SANITATION PERMIT Permit No. _...- S' „ }..vj (Complete in Duplicate) �j iveb�y jv Date IssuedOaApplication rad to the oaquin Local Health District for a permit to construct and install the workherein described. Thisa licatade in compliance with Count Ordinance No. 549. pp p Y JOB ADDRESS AND LOCATION---_�,?!�/_ -------,d---A__Q•----------------------------------------•---•-- Owner's Name---------1p.__qnte_-------- 9 ` —------------------_- ------ Phone------------------------------------ Address-------------------�'b_ _9.-• Contractor's Name------ h F--•------------•----•------------------------------------- ----------------------------------------------------- Phone---- —G Z 8 -- --- Installation will serve: Residence JA Apartment House E] Commercial F1 Trailer Court ❑ Moto E] Other ❑ Number of living units. _______- Number of bedrooms____ Number of baths -J._j,.Lot size -____-_'9__.___ �0------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ .. ff. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel-❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 1I New Construction: Yes'W No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) �* Septic Tank: Distance from nearest well_- --'--Distan e�from oundation----Zo---------Materi l_.i'e No. of compartments---- -�„�- Size--- -- - ---------------Liquid depth----- �---------------Capacity__-- ---� -----� i ® _ Disposal Field: Distance from nearest well.__- P-_-Distance from foundation_.v _-. .._.Distance to nearest lot line___J_/__________ r! Number of lines---.--------�_______________ Length of each line__§_-___ _�"s" -------- - --Width of trench_-_._'L_4-.-_--------- �. Type or filter material_---'?�-----Depth of filter material____. _lE____.____.__Total length----------6M------------ Seepage -__-_-_-__ Seepage Pit: Distance to nearest well_____________ Distance from foundation------------------- Distance to nearest lot ❑ Number of pits-------------__-x___Lining material-----------------------Size: Diameter-----------------------Depth---------------------------- -• Cesspool: Distance from nearest well__,--------------Distance from foundation--------------------_Lining material--------.-----------.---------------- El _-__-..-_____❑ Size: Diameter--------------------------- ---------Depth------------------------------------------ ---------liquid Capacity-.--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-________._.---____-_________._.____.. ❑ Distance to nearest lot line------------------------------------------------------------------------ ---------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------- ----- -- ---•--------------•----------------------------------------------------------•----------------------------------------•--••-------------------------------------------------------------------------- ------ -----------------------------------------------------••----------------•-----------•---------------------------------------------------------•---•----------••------------------------------------------------ ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- ---•--f�'� ...... - --------------------------- -------------------- --------------------- -------------------------------(Owner and/or Contractor) BY:aN.--------- 1 Ti- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE------. --P � -3 A ------------ REVIEWEDBY---------------------------- ---------- --------- ------------------ ------------ -------------------------- ----------------------------- BUILDING PERMIT ISSUED---------------------------------------- — � DAT ------ --- - --- ------••------- Alterations and/or recommendations:_ p.� ..°__:S --- ._____ ---�-- ------------- -- .---------------- ------------------------------------------------------------------------- --- � ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------ ------------------------------ ------------------------ ---------- -------------- ------------------------------------------------------- ------------------------------------------------- FINAL INSPECTION BY:.--A�/Av- Date---- --- ------ SAN ----SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+ort, California Lodi, California Manteca, California Tracy, California ES--9-2M 10-52 Revised W-2100