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' Permit No. .._�- 1..1-_ APPLICATION FOR SANITATION PERMIT 1 // I (Complete in Duplicate) Date Issued _ l--�1__�_ ------ 1 This Permit Ex ires 1 Year From Date Issued rk h Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the woere�indescribed. a This application is made in compliance'..with County Ordinance No. 549. JOB ADDRESS AND LOCATVON _ _ Phon -------------------------- Owner's Name-- --- Address. • - '` « - r -- --------------- Phone------------------- ------- Contractor's Name ----------•----•----•---"---"" Installation will serve: Residence Apartment House El Commercial ❑ Trailer Court ID Motel ❑ Other [I � _t---- 1'� Number of living units: _�-__._ Number of bedrooms -." Number of baths . ----- Lot size _____________ ---•--•---•------------------------ Water Supply: Public system ❑ Community. system ❑ Private,W Depth to Water Table .— ft. m ❑ Clay ❑ Adobe❑ Hardpan C]Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam jk Clay LoaVA: Yes ❑ No [IPrevious Application Made: Yes ❑ No,® New Construction: Yes,po No ❑ FNA/ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -m on-_.- 0Materiai---- -- ! --------------------- Distance from nearest well _Disetci ___ ___.__ - . 77 Septic Tank: q p - oJ o. of compartments------ ---N x 29 al Field: Distance from nearest welLO----------;Distance from foundat'on-.fQ�----------Distance to nearest lot line----------------- -------------------- Disposal . "" -----• Dispos !Len th of each line-----0-------- -..........Width of trench"� -------------- ® Number of liries__ . """ .--- - -------- --------- g r - � De th of filter material---.�E�------------Total length---,�-��--------------------------- -- --- ---"---------- Type of filter materia - P Seepage Pit: Distance to near st well------------ -------Distance from foundation-------------------Distance to nearest lot ine._-____.__.-___._ �. ' ❑ Number of pits- ------------------Lining.,,material------ ------ -------size: Diameter-------------- --- ---.Dept _. ------ ------------------ -- Distance from nearest well -�___3_Distance•from foundation---------------_____Lining material-----------------------------------s Cesspool: --------Li i Capacity ----------------------- g s ❑ Size: Diameter-- ------------'---------- Liquid Capa 't - a Ibuilding------------------------------- ---------- Privy: Distance from nearest well------------- {,Distance from' buildin l --------------------------------------------------------------------- Distance loft line----------------------------- ------------------ - ----------------------------------------- ( and/or repairing des ri istance one Remodeling / P g ] trEbe] ---------------------------------------------------- } ---------- ------------------------------------ } - --------- i ----------------------------------- -----•-------- --------------------------- fil I hereby certify that I have prepared this al5plication,and that the work will be done in accordance with San Joaquin County I y 01 L ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � and/------------------(Owner or Contractor) ------ --------- ------------------ ---------------- • {Signed) t i ---------------- - ellsbuildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to w , . FOR DEPARTMENT USE ONLY ------------------------ ------ APPLICATION ACCEPTED BY k*rx DATE-------------------- ----------•------------ REVIEWEDBY-------------------------------- ----------------------------------------------------------------- ------ DATE------------------------------------------------------------ BUlLDING PERMIT ISSUED ---------- J. Alterations and/or recomme afo s- ----------------------__.._-__"_ , -^ ' ------------ rx.�---------------------------- -------------------� ------ -- - --------------------------- - --------------- 0 + ------- 7 ------ .. ._�... q ______ ------------ ------------------ --------------------- --------- --------------------------------- --- ' ----- ----------------------------- SAN - -- -- ------- Date------------------------ -------------------------- ------------------------------------------ FINAL INSPECTION BY:...--.- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street i,� 300 West Oak Streot Tracy, California Sfiock+on, California Lodi, California Manteca, California ES.92M Revised 8-'S9 F.P.Co.