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' r ,SyAPPLICATION FOR SANITATION PERMIT Permit No. iSaer (Complete in Duplicate) Date Issued �'1------------ lice --'-c c .- licay made to the Joa uin Local Health District fora permit to construct and install the work herein described.tion is e This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATIONa- �� C4-a - -- •------------------------ Owner's Name-------------------------------- ------------------------ Phone--------------------•--------------- Address------------------------- >� ..... ------ ------------------•-------------------•------------------------------------------- Contractor's Name------------- ` --------------------------------------------- Phone__- ---f----.-_ Installation will serve: Residence IV Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: j____ Number of bedrooms j--_ Number of baths __f--__ Lot size -------50_7_1_4Z-------------------- Water G2_7_1_4Z----------- Water Supply: Public system ❑ Community system ❑ Private T Depth to Water Tab€e ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No L-.# New Construction: Yes x No ❑ 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publics wer is available within 200 feet.} Se ti Tank: Distance from nearest well- Distance fro foundation____ _ /____.Materi p No. of compartments_--------�-_-------Size___-�(- -- _a------Liquid depth------------- ------------capacity------Gt-Q_d_�_ Disposal Field: Distance from nearest well....b-0-_Distance from four cat ion__--_//�_-------Distance to nearest lot lin _____� Number of lines________---�al-_____________ Length of each line_________I t,t____.Width of french------�_�___-___---__----� Type of filter material_____C7__ Depth of filter material______---------__.Total length-----------6-0_____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ 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 (describe):----------465,d,e --------` -- v d _________________ -------------------------------------------------------••---------------------------------------------------- ------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cerfify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordina,ces, State laws, d rules and reg ,lations of the San Joaquin Local Health District. (Signed) ff C-�. --jet-.4-4------------------------------------- - -----------------------------------------(Owner and/or Contractor) B (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--.____ --------- DATE------------- _-- ----------•------_-----------_-_-- REVIEWEDBY----------------------------------- - m--- ------------------- ---------------------------------------------------------- DATE---------- --- ---------------- BUILDING PERMIT ISSUED------------------------------- -'-------- -----1-=-^L--t- ----' *DATE------------r----------�----- , Alferations and/or recommendations: - ----- VaL ------- - ---- ------------------------------• -•-----------------• - ----------------------------_--- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- .. ------------------- ---------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------- ------------ ----------------------- -- ---- --------------------------------------------- ---------------------•-------- r - FINAL INSPECTION BY:.---- - Date-__ / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfoekfon, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100