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APPLICATION FOR SANITATION PERMIT �y Permit No. '7./.-r. __.._- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct annstall the work herein described. This application is made in compliance wj:tk County Ordinance No. 549. -L t�dg-_Q&c,— ZL JOB ADDRESS AND LOCATION '__s- --- ------- - -`_ - ------- fZ Owner's Name _ ---- --- •------------- one •----- ------------ ----- Address---------- � - Contractor's Name-------__ _ Phone,,;.,-.,- Installation " -urf ❑ ...- ❑ Other will serve: Residence ❑ Apartment Hausa Commercial ❑ ? ❑ Trailer Court Motel Number of living units:I _-Number of bedrooms Z_&mber of baths --- ___ Lot size ------ f{� �- •------••------------ Water Supply: Public' system ❑ Community system E] Private Depth to Water Tabl jo__ ft. Character of soil to a depth of 3 feet: Sand [IGravel Sandy Loam D( Clay Loam ElClay [IAdobe ElHardpan ❑ Previous Application Made: Yes [❑ No X New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material No. of compartments--------------------------Size---•----------------------------Liquid depth------------------------ Capacity Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------_----- ---------- ype of filter material-------------------------Depth of filter material-----------------------Total length-------------------------------------------- Seepage ---------------------------- -- Seepage Pit: Distance to nearest well__________-_____ _ ____Distance from foundation--------------------Distance to nearest lot line________________ N ❑ Number of pits------------------ --Lining materia----------------------- Diameter-----------------------Depth-rr------- ----- J ----d-------- Cesspool: Distance from nearest well___1�_Distance from foundation..._____-- 2 x .I !`�Cj n Lining materral ------ -- ----- Size: r - �- . t:Depth------/---------------------------------- --Liquid Capacity-- , -9-420--------gals. Privy: Distance from nearest well-----------------------------------______________Distance from nearest budding----------------------- Distance to nearest lot line-----------------________._ r y�' Rema i g and/or rept firing escribe):__:_ 1 - -�` — ! JJ . �r ________ __ +Y�r._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 regulations of the San Joaquin Local Health District. ed J r + (Sign }------ -- -------- --•- '' ----------------- ------------------------------------ -------------------------------------------------------- (Owner and/or Contractor) Y• 4 l �- /0------------------------------------------------------------(Title)------ ------------------------------•--------------------- (Plot plan, showing size of lot, location of system in'relation to wells; buildings. etc., can 6e laced on reverse side). g P _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- --- ---------------------------- DATE REVIEWED BY l DATE � .. --- -- BUILDING PERMIT ISSUED -------------------- DATE--- � �` ` A terafions and/or recommendstions______________________________________ w_R -- ---------------------------------------------- _____________________ ______� _ r - `. - ------ u- ► ----_.------- `��-- •------ ------------------ ----------- ----- FINAL INSPECTION BY--------- --------- ---- -- , - Date ----------------•------------------- -----------------... SAN JOAQUIN LOCAL HEALTH DISTRICT l '�Y�"�ericen $tree} , 300 West Oak Stree} �5�9 132 Sycamore Street 814 North "C" $}teat ti' lifornie Lodi, California Manteca, California Tracy, California y d 1-57 F.P.CQ. " r