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Permit No. -- -,3 APPLICATION FOR SANITATION PERMIT t (Complete in Duplicated Date Issued __-- Applica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. �. �- '----•----------------- --------------- JOB ADDRESS ARl-O LOCATI �-��-t--�•--��'-- ---- --� ---�'l-'�-- -- � �. ,�, -- Phone Owners Name____ --�- �✓- - ---•------- ----- ______ -------------•-----•----•--------------- --- Address_______ .�� -------------------------------------------------------------------- ------ ------------------------ Contractor's Name---- - rr Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other. f ---- Number obaths __ _ Lot size ---------------------- __ '__�T�---"'----/•---- Number of living units: ;� Number of bedrooms � S Water Supply- Public system Community system #❑ Private ❑ DepthJo Water Table -_____-. ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: Yes ❑ . Nols, 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 kine____________..._ ❑ Number of lines-----------------------------------Length of each line---- ----- -------------------Widfh.of french-.--.------------------------------ t, Type of filter material-------------------------Depth of filter material-------- =----Total length-----------•-------------------------- -- i r Seepage Pit: Distance to nearest well_________________.___Distance from foundation____.______.___..__.Distance to nearest lot line- ____.._____._ r 'Number of pits----------------------Lining material Size: Diameter :: -Depth--------------------------------- i jasspo Distance from nearest well________________Distance from foundation______-_--___ -_-..Lining materia_________________-------_--_---__-•_. ' ❑��'�` Size: Diameter--------------------- ----- Depth - Liquid Capacity gals. Distance from nearest well -------------------- - Distance from nearest building----------__-------------------------- - 1 Privy: s k ❑ to nearest lot line----=-". -------=- --------- - ---------- --•-•--------=-=----- -•=-----•--------- ----------------------------------------- -------------------------------------------------------- Distance a ---------------- "r. Remodelin rand/or repairing (de c}ibex=- -� f .-.--- , , -----------•-------•=-------------------------------------- ------------------------•--------- r ; ---------- _ i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County k. ordinances. State laws, and rules an'd regulations of the San Joaquin Local Health District. (Signed)---- " -------- Gri- r,,< '_e--- ---------------------------------------- --------- ------( � ( Owner and/or Contractor z 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-- A_ ATE- � DATEs._.__., ./ 1 ------------- ----------- j BY---------------------------------- -------------------------- -�--- ---- -� - - E r . DATE-- -- -- ---- - --------------- --------- --------- --- ' BUILDING PERMIT ISSUED--------- - if 1� a7- �5---��---- en Alt rations,an /or recomme atio ! s__ 5� 1 y --.. _� ' - - ------------- --- -- --------•------------------ ---------------------------------- ------- -------------------------------------------------- f . I - - ----.._.------------ ` Date--`--- -- �----•-------•- - ---------------------------------- FINAL INSPECTION BY:_^_:'- ._r _-- -j-- -= - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C• Street Manteca, California Tracy, California Stocuon, California Lodi, California 1 ES-9-2M Revised W-2100 -