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APPLICATION FOR SANITATION PERMIT Permit No. v` (Complete in Duplicate) , qc� Date Issued __-_ -----r....../- Application is hereby made to the San Joaquin Local Health District for a permitato construct and install the work herein describe This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAOwner's Name •--- ------------- ; -- --------- ------ hon�� 1�/ x Address - ---- ---••- Contractor's Name---- --- ---- ---"t ---- -------------- one. ... _ � Installation will serve: Residenceartment House ❑ Commercial ❑ railer Court ❑ Motel Other ❑ Number of living units: ___/__ Number of bedrooms._ Number of baths /_•_ Lot size Q_' _l-2._l-�_.._____:_________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-��ft. �. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes f No ❑ FHA/VA: Yes ❑ Nom( 1. TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) 1 eptic nk: Distance from nearest well-----------------Distance from foundation....................Material------------------------j No. of compartments--------------------------Size---------•----------------------Liquid depth--------------------------Capacity------------ Dis osal field: Distance from nearest well f p ___Di a e from foundation_�l�__--`-�----.Distance to nearest lot Ime�2�►;i�a `-�' Number of lines__ ---_t _A_ _ -_ _____________. fes? Len th f each line_______� �� ____.Width of trench Type of filter material _ _Dep o er maaferial---VX _ -- otal length_______/' ___ --'------•---- Seepage Pit: Distance to nearest well,�z `•;� istance ro o dation- ..Distance-to nearest lot Ione___'.��___-__ XNumber of pits_________ _-__Lining ny&rial ,3ize: Di eter-__, `6epth____-C1_ Cesspool: Distance from nearest well________________Dist011' fro_ undation--------------------Lining material------------___,_________•_________ ❑ Size: Diameter--------------------------------------Depth- -----------------------------------------Liquid Capacity ------ ------------g'� Privy: Distance from nearest well_________________ _______r:.__-____ _____Distance from nearest building_-___-__ -___ __- ______-: ❑ Distance to nearest lot line ------ - -------- ---• -- F--•------ ------------------------- ----• ------ -•-- Remodeling and/or repairing (describe):---A ----- -----:-------------------------w-- ------ --_- ------------------------------------------ - -------------- ........ ............ ------------------------------ --------------------- -•-- --------------------------•---------------------------------------------------------------------------- -•-•--- I hereby certify that I have prep d this application jpnd that the work will be done in accordance with Sr,'I'Joaquin County ordinances, S law d rule egulation they n Joa in Local Health District. ------ ' (Signed)--- --•- ---- ---_`;r - ---------I ------------------- •-(Ow, /or Contractor) By:-------------_ -- I -- -•• = ---- ----=�T a 4------- --------- (Plot plan, showing siz of, o at o system rely on to wells, buildings, etc., can 'Ved on r arse e). 3 wa FOR DEPARTMENT USE ONLY APPLICATION c4`CCEeTED BY-_ --------------------------- - ---- ----- ---- ----- DATE ------ -- - REVIEWED BY--_-------- ------------------ - DATE-------I -- - ------- --- .-.-.-.-...- BUILDING I'ER1aiT TS5i7E---D - - --------------------------- DATE •- ••, Alterations and/or recommen s---------------_---- =--------- ----------------------------------------------------------------------------------------------------- ------ 1--0----- --------------------------------.--..----.-.---..-.--..-.-.--.------------------------ ------- #...... --- _. -. ---- ------------------- -- ------• --------------- •--- - •<• --------;--------- ---------------------------- ----- ------------------------------------------ -- - -------------------- ----- ------------- -------------------------------------------------- -------------------------- FINAL INSPECTION BY:......=--------------------------- -•-----•--- ---------• Date-------------- ------rE._-- 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sou American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ockton, California Lodi, California Manteca, California Tracy, California ES-9. 2M Revisea 1.57 F.P.CO.