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r.�lr APPLICATION FOR SANITATION PERMIT �}�- J 5 --'C..i (ComPermit No.¢-plete in Duplicate) x Date Issued _--/__7 k�plicafion is hereby made to the San Joaquin Local Health District for a permit to construct Tr is application is made in compliance with County.Ordinance N . 549. and install the work herein described, t JOB ADDRESS A L ATJO,N---- �•/1�,�� /'fv •- ---- + Owners e_ + --.x------ _ ---------- Na I - Address.--- ------------------------------------------------•---- Phone_,_-x-112 t5i_ 4(� -- -------------- -- ------------- ontractor's Name-- -_---_ - - - ---------------------------------- -------------------------------------- ---- - -- ------------------- --- - Phone Installation will serve: Residence ------------------ 11 Apartment House ❑ Commercial Number of living units: __-L_ umber of bedrooms (_ Number of bathe railer Court ❑ Moi! ❑ Other Lot size -_ 0 __- Water Supply; Public system Communi# system � x�-�--�----................ -- -------- Y Y ❑ Private ❑ Depth to Water Table -- -__-_ ft. Character of soil to a depth of 3 feet: Sand / Gravel ❑ Sand Loam Previous Application Made: Yes Y Clay Loam ❑ Clay I] Adobe rdpan ❑ ❑ No 7New Construction: Yes LJ 1�0 TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ (No septic tank or cesspool permitted ' public VAIsew r is available within 200 feet.) J I Septic Tclnk: p Distance from nearest well---_ istance from fouPd inn___-- ___ No. of compartments-___-- Aj --- -----.MWa -e iaL---- __---- ---Size-- K f Liquid depth --------- 3 - ---------Ca aci Dispos Field: Distance from nearest ellp � �� ---- istance from foundation__-_/0----__ Number of lines___- --_- Length of each line.--- _ Distance to nearest lot Ii Width of trench-_-----__ ___ Type of filter materia! '�epth o{ filter materiaL____1_ ----- ------ - -- Seepage Pit: - ---------_Total length----_ __-- Distance to nearest well----------------- -Distance from foundation------------------- 11) ElNumber of pits--------------_--__--Lining material------------------------Size: Diameter___ Distance to nearest lot line----__-----_-__-, �- Cesspool. Distance from nearest well-----------------Distance from foundation-- Depth____ ___ __ __ ❑ Size: Diameter------------------------- --- -- ------ Lining material__---------------------- ----------- ------------------------------------------- ------Liquid Capacity Priv ' Y: Distance from nearest well ------- ------ -------------gals- E-] Distance to nearest lot line- _- __---_-Distance from nearest building-__-------------------------------------------. Remodeling and/or repairing (describe ------------------ - --- --------------------------- -------------•--------------------- :-------------- ----------------------------•------•------- •---------•--------------------- ---------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- t --- 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 reulations of the San Joaquin Local Health District. (Signed)------------- ----r By:------------------------- Owner and/or Contractor) (Pl -.........................---------- Tale _ _ ______ - ot plan, showing size of lot location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE:ONLY APPLICATION ACCEPTED BY--- _-_ REVIEWED BY DATE ------- --- - ---------------------- ----- ----------------------------------------- BUILDING ----- PERMIT ISSUED----------------- DATE_--- --- Alterations and/or recommendations A DATE-----_ --- -------------------- -------------------- r ------------------------ - -- t FINAL INSPECTION BY:_--_ fl . _xI__:-_ ------------ ----- Date �--�-- -- -•-- ------...- �-- -- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300West Oak Street 132 Sycamore Street 814 North "C" Street Sfockton, California Lodi, California Manteca, California Tracy, California ES-9-2M a-51 Revised W-2100