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u '7 ate-5 d 9PPLICATION FOR SANITATION PERMIT Permit ' 6 (Complete in Duplicate) 7 �t {j Date Issued ._ A_ Application is herey made to fhe San Joaquin Local Health District for a permit to construct and install he work herein described. This application is made in compliance with County Ordinance No, 549. X37 f— 2_50—L(2 JOB ADDRESS AND LOCATION.___ _-------- Owner's _ _- Aew/i?,Vj XOwner's Name ------ Phone-----"�— ��------------- Address- - - ------------------------- ------- Contractor's Name ,.a�..�-/'� Phone - 13_ Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _11--Number of bedrooms umber of baths ___ Lot size _ _____. ... _ ---_________________:_-_ Water Supply: Public system Community system OC Private ❑ Depth to Water TaHev-.4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ' Previous Application Made: Yes ❑ No X New Construction: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puUc §ewer is availa6le within 200 feet.) 1 _ Septic Tank: Distance from nearest II _ Distance from fountionla-------------Material__6--------—-------- No. of compartments__ --Liquid de th_ _"- 7 .. q P ---------Capacity-IQ4l2 i Disposal Field: Distance from nearest wef .00_-._.Distance-trom foundation__/B_-__------Distance to nearest lot line----- Number of lines________/____________7 _--engfh of each line _ Width of trench---AL_4�'"----------------- �} I Type of filter material. - epth of filter material-----_1lf'`------Total length---- --------------------- Seepage ength__- '------------------Seepage Pit: Distance to nearest well '_-----Distanc fro foundation___l_A ___Distance to nearest fot Number of pits-----�_-------------Lining rnateria� V41.---Size: Diameter-----.3-.?---------Depth_c:5,V_ ----------------- Cesspool: ___.__-----Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining materia!----------------_-_________.._.__. i El Size: Diameter--------------------------- ------Depth----------------------------------------------------Liquid Capacity---•-----------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________-.-_----_____ ❑ 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, d rules and regulations of the an Joaquin Local Health District. r, (Signed)----- _A ---------------------------------------------------------------------- -# r Contractor) i B _ _ -------- --- i----- -- ------ ---------------------------------------------------------------(Title)---L 1.-�- otZ- .--------------- (Plot pla • g size of lot, location of sysfem rela to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- �----------------------------------------------------------------------------- DATE_----..---------------------------------------------------- REVIEWEDBY ------------------------------------------------------ -------------------------- DATE----- t5_------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------- ----------------- -•--------- Alterations and/or recommendations---------- ---------------------------------- -------------------------- -----------------------------------------------------------------------------------------------•------------------•---------•------------------------- ---•-----------------------------•-•-------------------•------------------------------------------------------------------------------------------------L--=------------------------------------------------------------------ ------------------ ------ ------------------------------------------- ------------------------------------------------------------------------------'=-------------------------------------------------------------------- FINAL INSPECTION BY:------- 4WY ' --------- ------------ Date-----2 - `�- -- --- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+rest 132 Sycamore Sfree+ 814 North "C" Street Sfockfon, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised 'W-2100