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jPermit No. APPLICATION FOR SANITATION PERMIT r [Complete in Duplicate) Date Issued _7Y__�_--- - 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 in compliance with Coun y Ordinance No. 549. -" - - ------ --- =----- - JOB ADDRESS AND OC TION--------- Phone - t ----------- _---- ' jC" -----•------------•--------------------------------- Owner s Name_.__-_ -----•- --------------------------------------------------_ ------------------- Address. -�- ------ Phone Contractor's Name---------------- . Installation will serve: Residence e—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other' / - Lot size __ -------------•------- � �,.,�--- Number of baths _�- - Number of living units: __-.___- Number of bedrooms . _ � ' �� Water Supply: Public system F1 Community system ❑4 Private Yr,Depth to Water Table ft. Sandy Loam El Clay Loam l�6ay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ❑ � 'Previous Application Made: Yes ❑ No V11 New Construction: Yes ❑ No ( � TYPE No septic cLtank o ces cesspool Permitted fitted if0 ( public sewer is available within 200 feet.) p � i Septic Tank: Distance from nearest wel�,_, �----Distance from foundation____�Q-.-.-.--Mater I_ __.______________ No. of compar+mems----- --------- --- --Size X,9-0_,tC__�OLiquid depth__---_'1�. ----------Capacity_/24, -- i �2D_: _Distance to nearest !o+ © . Distance from foundation___ i..._.. Disposal Field: Distance from nearest welt___ __________ _ --- -- Width of trench.--__-.---4-t" ----------------- Number of lines----- Length of each line___._____. �. _Q Type of filter material__�Z_--.-.- --- ---Depth of filter material_._._. --F----Total len th------- Seepage Pit: Distance to nearest wgll____` -------Distance from found ion__ .------Dist `�e to nearest to - e. Diameter.---_7 ----------Depth.--- w Number of pits-----------------------Lining material__4 '-- f Distance from nearest well_______-____.___Distance from ------------------ material____._--_--------------------gals. Cesspool: ---_Li Liquid Capacity_ 9 ❑ Size: Diameter-------- --------- ------ Depth q P Y ----------- ',Privy: Distance from nearest well___-___________________ Distance from nearest building-----------------------------------------1, ❑ Distance to nearest lot line----------------------------- i • Remodelin a / repairing describe,:_ --- -------.� •_ -____-_ _______ _________________________________________________ _ _ _� _-___ _ __.____-`U_4--�J_____ __ _ �__ __ ..._____.________._____________.._ _ - _____---------------__-----------------------________________________________________________________ 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. R on act (Signed) C tr or By:----------------------------------- ��'----- --------------------------- -----(Title) f (Plot plan, showing size of to;, cation of system in relafion to wells, buildings, etc., can be placed on reverse s" e]. �! . FOR DEPARTMENT U-SE ONLY { DATE----------->----------------------------------------- APPLICATION,ACCEPTED BY'---I,--------------------- --- DATE- __I-- ------------------------------- REVIEWED BY------------------------------------ ------- ------ ----- - - � - --------- --------• DATE.---------------- --- ------�------ ------------------- BUILDING PERMIT ISSUED------------------------------------- ----- ....... ------ --- Alterations and/or recommendations:------- -------- -------- - -- ---------` ----- 1 ------ ------- .. ..� i - , -------- ----•--- ----------- (y ----- ---- -- - ------------ ------------ FINAL INSPECTION BY:.__ - . ----- -------- ------ ' -------- Date.... ---SAN JOAQUIN LOCAL HEALTH DISTRICT t � 300 West Oak Street 132 Sycamore Street $14 North "C' Street `130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California �5-9—zFn 545446 nzwano 12-54 __