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l APPLICATION FOR SANITATION PERMIT Permit No--5-• (Complete in Duplicate) Date lssued�----- - is hereby made to the San Joaquin Local Health District for a permit to construct a Il the work herein described. Application ��n� (�/Fl �' This application is made in compliance with Count Ordinance No. 549. J r", FA 1 e JOB ADDRESS AND LOCAT ON------------- .• ---------------- Phone-------------------- d ' Owner's Name___-- ;, -----•------•- ----- - ----- Phone----------------------------------- -----------A-p-•ar-----•--- ----•--------•House [I------------------------------------ ---------------- ---------------------- ------------ Other El Contractor's Name-------Re -den -•------ tment Commercial ❑ Trailer Court E] Motel ❑ Installation will serve: Resience ----------_ �_._ Number of baths .-r.-- Lot size ___�-- � . Number of living units: _ --- Number of bedrooms Public system ❑ Community system ❑ Private 0, Depth to Water Table ft. .a� Hard Water Supply: Pub Y San1_1Clay Loam ❑ Clay E] Adobe Adobe❑ P E]Characteraracter of soil to a depth of 3 feet: Sand � Gravel F1d Y Loam New Construction: Yes 11 No F1' previous Application Made: Yes E3No PS ; _ . TYPE OF INSTALLATION AND SPECIFICATIONS: ,» �- (No septic tank or cesspool permuted if public sewer is available within 200 feet.] �� '- ,�.. r r Matelial_.__ Distance from nearest welL____,�D__ -__Distance from fou da#ion_- : --- Capacity � 5x a P. Septic Tank: Size-- -- -- L;quid de th ---- �--------------- P Y---- •a No. of compartments_-___-Zr--- Distance to nearest lot lin�___.'�------.--- Distance from foundation.__ -� ----------- Disposal Field: Distance from nearest well_.-'�D.�----- Width of trench------ ----------------------- Number of lines___-__l----------- Length of each line___-1__Z--------.--- �{ 4 _Depth of filter material----- - ---........Total length______7..L ----------• d Type of filter material-- -� oQ - Size: Diameter ------ -------- ----Depth--------------- Seepage Pi}; Distance to nearest well,-___-----.--:-------Distaai e from founda#ion____________________Distance to nearest lot line_____...___.____- Linin mate -------------- Number _ �! ❑ Number of piles_---- gf ` -Liquid Capacity gals. Q Cesspool: Distance from,nearest well-----------------Distance from founda#ion__.__._..----------.Lining material y__-___.-__---_-�---- ��-- -��- ❑ Size: Diameter-------------------- , Distance from nearest building----._.__---------------------- ---- Distance from nearest we _-------- ----- ----- ------------------------- ----------------------------------•------------- ----- .. Privy: - ---------------------------------------------------- -- - . ❑ Distance to nearest lot line-------------------- „ 1 Remodeling and/or repamnq �descnbe}--------------------------------------- --------------------------------------•------- --------------------------•------ -----------•-- 1 - "' . ------ --- - ---- - - -----`-------- ----- --------------------------- this application an Joaquin the torkHealltheDis done in accordance with San Joaquin County hereby certify that I have prepared } t. ordinances, State laws, and rules and regulations of the q (Owner and/or Contractor) =-i------------------------------------------------- Si (Signed) +- 9 ) {, -- - --------------- (T�t By------------------------------------ g (Plot pian, showing size of lot, location of system in relation to wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ DATE----- -------------------- --- ---------------------------------------------------------------- --------......------------ APPLICATION ACCEPTED BY.---..-•----- ---------------- DATE------------------------------ ------- ------ DATE-------------------------- REVIEWED BY--------=-------:------- --------- - -- ---------------------- BUILDINGPERMIT,ISSUED--------------------------•--- ------------------- -----------•------ --------------------------------•----------------------------.----- Alterations anQor recommendations:_-------------------------------------- --------------•------------------------------- --------------------------------- ----------•--•--- --------- ------------------•----•--- ----------------------------- --- ---- ------ --•• ----- ----------------------------- -- ---- ---•- - ------ ------ / -- Date----------- --- ---------- -- FINAL INSPECTION BY:------ -F-----, UIN LOCAL HEALTH DISTRICT SAN JOAQ i 132 Sycamore Street 814 North "C"'•Street y 300 West Oak Street Tracy, California ,. 130 South American Street Lodi, California Manteca, California Stockton, California ' FS-9-2M I0-52 Revised W-2100 "