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O - A # TJON iFOR SANITATION PERMIT w'Permit N =: _. __ (Complete in Duplicate) Date Issued/��7��"✓ rplicaton is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with County Ordinance No. 549. 6 r JOB ADDRESS'AND LOCATION------------ � ., -- Owner's Name_... -� C-� �'�� --------------------------.- Phone-__ = " --------- -------------------- --------------------------- - Address ----------_•--------------------- ., Contractor's Name-------- - --- ---- _-------- Phone--------- A Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer,.Court—❑ Motel ❑. Other Number of living units- .;P!5Number of bedrooms �mber of baths I--- Lot size ------ Water Supply: Publicstem ommunify system -El Private E] Depth to Water Table -------- ft. .._. sy Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeafdpan Q Previous Application Made: Yes ❑ No New Construction: YesQr -f� 5. 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__ ----------Mat _____________________________ __ �.------- No. __ No. of compartments_-----___ ' _ Liquid depth_________________________Capacity__.. --- Size = ' Disposal Field: Distance from nearest well--- -Distance from foundation_-__A�i__ Distance to nearest lot line-__.� __- Number of lines____________-------1-1-- �®--� Length of each line__-:..____'_ r___ Width of trench=_.___.___��__`_. Type of filter material________" xK__De th of filter material______ __ __________Total length____-__- _b -C2_____I __,____._. '. p li- eepage Pit: Distance to nearest well- -------------------Distance from foundation--------------------Distance to nearest lot Ii e------., ---- S-, ❑ Number of pits--_ L�nm ater a _.Size. _diameter__ w;;M.-u Depth Cess ool': Distance from neatest well Q�stanc �h .r ` . . T _ Liquid Ca aci gal �. ----------= Privy:, Distance:from�nearet we1!'_____ ______ _ ______ ____ _ ______ _Distance from nearest building___ a - ❑ Distance to nearest lot line------ --------- ----------- - Remodeling and/or repairing (describe)---------------------- -------------------------------- ---•------- ------------ ------------------ -------------------------------•-----------•--------------------------------. ----•-------•---------------------------•------------------------------------`--------------------------------1-------- - - --= 1 ---------------•------------- ------= -----------------—-----------------------�p--------•---------------- ------------------------- = ------------------------------------------------------------- I hereby certify thati have prepared-this application and that the work will be done in accordance with San Joaquin Co my ordinances, State laws, and rules nd regulations of the ! San Joaquin Local Health District. .--L-.( weer and/or Con n actor) . ---------------------------;-------------------------(Signed)� . . - ' -----------------------------------------------------------------------(Title) . (Plot plan, showing size of lot, location o� system in relafion-to wells, buildings, etc., can be placed on revere side). FOR DEPARTMENI'_USE ONLY r- Y ... _ - - DATE.---------- �. � f-`- _ :. APPLICATION ACCEPTED BY------------------- -- ----- = —:. _ _. : .N BY------------- ---- ----- ---------'------------- - DATE = --------------------- -------------- REVIEWED BUILDING•PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------- --------•.---= ry Alterations and/or recommendations:__-.- - ---- '`' "------ - - „'- ----- - ---------- -tk -^ ____ --------------- --- ___________ - ------------------------- ---------------------------------------------------------------------------------- -------------------- -------' --- _--------------- f PINALINSPECTION BY:------ --- --------------------------------------------- Date---------- =-----=---------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ' 300 West Oak Street 132 Sycamore Scree} 814 North "C" Street r Sfockficm Califomia Lrodi,,'Califa nia 1�$n#eca Cefifo��i"ia� Tracy,,C lid forrtin. 4 '21v13; 4e+viser] Y1V-2OD y s .na xy,