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[i APPLICATION FOR SANITATION PERMIT 0Permit No. - elf .. (Complete in Duplicate) 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 No. 549. 5 a JOB ADDRESS AND LOCATION ``� /r � - �� eye'r�'1- - ---------------------------------------------------- Owner's Name--------------E------- �I� ----•- --------- ------------ ---------------- -------------------- -------- Phone--------- -_---------------------- Address-_---------------------------------/ _---------------___----Address---•---------------------------------/ v-• l /r/j @'tr�c''-- -- ------------•-----------------_-------------- f L i Contractor's Name------•--------_-_--•------� '---�'--- -v��= � �`" ------------- Phone---------- ------------------------ Installation will serve: Residence Apartment House t Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,1____ Number of bedrooms ___Z). Number o aths _ --_ Lot size -----.---___--------------------------------------------- .__ Water Supply: Public system E] Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑F,Clay ❑ -,Adobe❑,--`IHerdp`an❑��'�' Previous Application Made: Yes ❑ No B�New Construction: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi5Aewer is available within 200 feet.) Septic Tank: Distance from nearest well__,- {-___Distan from found tion__Z_d____-___-Material---tea'--�+ �__'________________ No. of compartment s__._.__ -- _-.---_Size_ /r--�j-� -- --Liquid depth______3---------------Capacity___ __.&,0--(_7____ Disposal Field: Distance from nearest well...6-i-------Distance from foundatio_,9.0 Y_ Distance to nearest lot limy Number of lines:_1___._3-....-..--. Length of each line_7a1_. � j-_.Width of trench.-.- _��__.__��_--____-___� Type of filter material----fy� Depth of filter material---,�.�_._ ------.Total length--------IT -----------------------S f Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------- F] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------_-----Distance from foundation------------------- Lining material_____- ------------------------------- -I ❑ Size: Diameter-- ------------------ - - -----------Depth----------------------------------------------------Liquid Capacity-- --.---- --------_ gals. .;..,Disi.ance--fromrnearest=well'- ----------------------------------------- i-stan—ce-from nearest uildin ❑ Distance to nearest lot line-------------------------- -------------------- ----------------------------- g----------------------------------- ----------------------------- Remodeling -------------------------Remodeling and/or repairing (describe)---------- -------------------------------------------------------------------------------------•--------------------------------------------------•---- •� s ---------------------- --------------------••------------•---•-••----------------------------•--------------------------------------- f i --•---------- -------•---------- ---•-----•----:---------------------------•--------------------------------------------•-----------------------------------•--------------- ----------------------------------------- ------------------------------------------•----------•--------------•-------------------------------------------------------------------------------------------•-------------- 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 rules and regulatiofis of the San Joaquin Local Health District. 3 .. (Signed)-••----•- vim = -------' !' ,..., ___-_-__- Contractor) - By:----------- r Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, Oc., can be placed on reverse side). .� FORD TME USE OgLY - APPLICATION ACCEPTED BY -' ----•• ------- DATE �l � r REVIEWEDBY------------------------- ------------------ ------------------------- ---------------------------------------- --------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE----------_------------------------------------------------ Alterationsand/or recommendations---- ------------------ --------------------------- -•---------------------•----------------------•--------------------•-•---•--•-------------------••------- -•-•-------- 4 ___________________________________________________________________________________________________________________________ ___________________________________________-______-_-_--_.---_-__---______-__-___-_ . __________________________________ _____________________ i • _ _ } ____ ______________________________ FINAL INSPECTION BY:---- Date-- _________� X;_�_ -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street b,., ti130 South American Street 300 West Oak Street ' $toek+on, Manteca, California Tracy, California California Lodi, California Fr-9-2M 145446 ATWOOO 12-54 1