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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued-4/1-1/_5 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 Ordinance N01549, JOB ADDRESS D LOCA N_.-_� 0 Z � (� ------------------------------- --------- 45, Owner's Name ------- Phone-.3 �f.1 ----- Address -'----------- ------ --•-------•------------------------------------------------------------------------- -•--------------------------- Contractor's ----- ----- ----------- Contractor's Name----- ------ -- -------------- ------------- ---- ----------------•------ -------- Phone ---------------•------ Installation will serve: Residence!I Apartment House F] Commercial ❑ MotI Commercial Trailer Court ❑ Other ❑ Number of living units: 1_. Number of bedrooms ___I__ Number of baths __�___ Lot size _-_4-1C9__ -_>_tq� - ----------------------- Water Supply: Public system Community system •❑ Private [❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand . Gravel Sand Loam Clay Loam Cla ❑ Y y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well__ _044- jistaZilfrorn q Foundation_-___ _D-____Mate i f .i!`-- -_No. of compartments_______ Size__ x.�1-_ _Liquid dap h ----------Capacity - Disposal' f=ield: Distance from nearest well �( i - - - s+ante from foundation___Z__1--------Distance to nearest lot linet.r- ---___._. Number of lines___________ ___ __ _ ___ _Length of each line----------------6-1(------- of trench. ___?JIse - Type of filter materi '_ __ __ epth of filter ma+aria) __ --------.__Total length---------- ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- El Number of.pits-----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--------------------------------- { Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-'___________________________ ------- ❑ Size: Diameter--------------------------------- ----Depth-----------------------------------------------------Liquid Capacity- ----------------------- gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line ---------------------------------------------------------------------------•---------------- Remodeling and/or repairing fdescribe)-------------------_-------------------- I ----------------------------------------- -----------------------------------------------------------------•------------------••-------------------------------------•---------------------•----- ---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State..) wsland rules and regulations of the San Joaquin Local Health District. � / -� ..,.----- - ----- ` (Signed)---- ;----�.. - -- ---------------------------------- --- ------------- ----------(Owner and/or Contractor) By=- ---------------------I--------------------------------- --------------------------------------------- Tale (plot plan, sh in 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-— ---------------------------------------------------------------------------------------- REVIEWED BY---------------- ---------- �-------------- --------------------------------------------------------------------------- DATE .� BUILDING PERMIT ISSUED _ - ------- DATE----------- - - - Alte tions and/ rec6rnmendatidnns:r-------------•-6---------- -------- ----- " ------------------- ,-- --=----------- ,� A ----�----- -- ------- -- -- +�� C;�, ¢ .H! ---- --------- l' l4 - ' --------------------------------=------- ---- - - FINALINSPECTION BY-----------------------------.-------------------------------------- Date-- ----•------------------ ------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street Sfock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 9-51 Revised W-2100 R