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Y �f f APPLICATION FOR SANITATION PERMIT Permit No. __ 3-----___-- (Complete in Duplicate) pate Issued �_�_1! �S/ Application is hereby made to the San Joaquin ocal Health District for a permit to construct and install the work herein described. This application is made in compliance with C my Ordinance No. 549. JOB ADDRESS AND LOCATION------ d-C- .... _- 3r 0 --- ABT•-`�7-------------------------- Owner's Name--------------- k 1- ------------�` ih--------- --------- ------------------------------------------- Phone------------------------------------ Address-----------------------------•-----........,-/-- _- ----------•-------------------------•------------.. ---------------------------------------------------•---------------- -------------------------------------•- Contractor's Name-----•------•----,0414-4.1--------------------------------•----------------------------------------------------------------- Phone---------------------------------•- � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: !_____ Number of bedrooms __Number of baths ---/__ Lot size .--464_X-.',1et ..______._____ Water Supply: Public system ❑ Community system ❑ Private )q Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ i Previous Application Made: Yes ❑ NoNew Construction: Y0'❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: '00—El � (No septic tank or cesspool permittedif p�ublic s wer is available within 200 feet.) Septic Tank: Distance from nearest well_Q.. . 1Distanc fromundation__. _ _ ,.Mate'rj�'I _�_*._ ( ____,_______ No. of compartments_-_-..- ----..-.--Size _ �iquid de th---------�f...___._.__Capacity..--1 Disposal Field: Distance from nearest well__- istance from foundation___ _Distannce to nearest lot One__ ____ ___. Number of lines___________s�� _ ._ __Length of each I ne___ rCa� --.Width of trench----- ___P _________ Type of filter material__ __I�.___ !,�._Depth of filter material---- -_ .1� _ ___Total length______-___ __Q--- ______._. ' 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--------------------•------= �._��ei�t� � �v------------__µ Liquid-Capacity--------------==-------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building __._._. ❑ Distance to nearest lot line----------------- -----------------------------•---------------------- ------------------------------------------------------------------- Remodeling and/or repairing (describe) ---------------------------------- --------------------------------- --------------------------------------------------------------- -----------------•-------------•-------------------------------------------------------•------------------------------------------------------------------------------ ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Local Health District. (Signecik9� -- -- ------ ---- Owner and/or ) State laws, and rules! a �e u�.t� o t� -aw Joaquin -------------- -- Contractor By: ------------------------------------ (Title) (Plot 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.--- ---- --------------- - ---------------------------------- DATE - i--�S-C--------- REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE------ ------------------------------.---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------- ---------------------------- Alterations and/or recommendations--------------- -- - - -- - --------------------------------_-------------------------------------------------•------ ----------- ---------------------------------------- --------------•------------------------------•-- ------------------------------------— -- ----------------•-------------------------------------------------......---- -------------------------------------------- ----------------------------- ----------- ---------- ----------_------•---------- ---------------------------------------------------------------------- ------------ -------- FINAL INSPECTION BY:--- ------------------- ----------------- Date........ __... -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi. California Manteca, California Tracy, California E5--.9-2M 145446 ATWOOO 1254