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APPLICATION FOR SANITATION PER Perini (Complete in Duplicate) 511V /- Date issued 7ii7 /,9435' I Application 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 No. 549. p , ADDRESS AND LOCATION__�Cf-_1;7 --- -------------------------------------------------- JOB , 499 ---- �Gl , fi1-1i1P..�?A Y Phone '------ 4 Owner's Name__.__________________ r� Address-------------------•-----•------•-----4 -D - fi� 7 1L4.. "� k Contractor's Name--------•----_----------- [ � - �' � 'fir ..� _ Phone----- ��+fa. ....... Installation will serve: Resident Apartment House Commercial ❑ Tr a'er Court ❑ Motel ❑ Other Number of living units: _ Number of bedrooms -✓ - Number of baths _ ____ Lot size -- _____----- ---------------- I. .Wafter Supply: Public system ;K 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,` No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r ` Septi Tank: Distance from neares+ we _ __Distance ;r foundation_��_________-_-.�W� �.-________ 1 .� �j No. of coin artments_______ e,re _ __AO x p Siz f�-'_ .-Liquid depth--- CapacityD _ lcy+. Disposal Field: Distance from nearest well__A1l�___Dista�� from fo ation ...........Distance to nearest lot line________ ® �+ Number of lines_________ _ Length of each line------- _�4 '_-Width of trench____* _'_________________ Z-' n---- - ------- Type of filter material- __ ___ -_ _-Depth of filter material___�2_r'`_________Total length_____ _�_____________________ 0& Seepa e Pit: Distance to nearest well_ '1�-�_____Distance from foundation_4-C_.......Distance to nearest lot I'n,e___,�_0_.00__. Number of pits_____'----------Lining material_ -------Size: Diameter---�o��e P s r� - Cesspool: Distance from nearest well-----------------Distance from foundation_'._-----.-------Lining material_______-____________________._..__--- ❑ Size: Diameter------------------- ------------------Depth----------------------------------------------------Liquid Capacity ----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.------------------------------- Q El . I 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, State laws—and rules and regulations of the San Joaq in local Health District. (Signed)-- ------------- - -- ---- --- -•�""-------- = mr Contractor .. _ i __ __ _ _______________________________Fced .. ° = ----- ---------------------------------- frtlel -- - ------------------- (Plot plan, sho► ing ize of lot, location of system rn relation to wells, buildings, etc., can be plon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_ PATE,; --------------------------------------------- REVIEWED BY---------------------------------- DATE--- BUILDING PERMIT ISSUED =------- ------------------------------------------------ ------ DATE-------- --------------------- Afteratians and/or recommendations: -- =-------------------------------------------------------------------------------------------•---- -----•------------------- ------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ f �r FINAL.INSPECTION BY: Date P------------------------------------t-------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Sfockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M $-51 Revised W-2100