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11 l S APPLICATION FOR SANITATION PERMIT Permit No. -- .--Q-- r1p (Complete in Duplicate) Date Issued zn Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tkG PP work herein described. This application is made in compliance with County Ordinance No. 549. . l/i, JOB ADDRESS AND LOCAT ON ; �62 -�y may-------------------- ----------..-- /y ---._. Phone_7 a- Owner's Name _f/_lE��. Address . / 4 ` -0�.--0- .-- &,;?r __� r ---- - ---... Phone_ Contractor's Name--------- - -- - • ---------------Pq.,7..r_ - Installation will serve: Residence Ra---A ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __f__ Number of bedrooms ---41- Number of baths ._- __. Lot size __/___ __ _____ ------------------- Water Supply: Public system ❑ Community system Z-1-Private Q Depth to Water Table _�_0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ "Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Application es ❑ Previous A Made: YNo [�rNew Construction: Yes ElNo Ei 4' R-e� TYPE OF INSTALLATION AND SPECIFICATIONS: I [No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank- Distance from nearest well-________________Distance from foundation_________-____...__.Material_._._____._."____.______"".__--____._.""_____. , Li uid de th-- Capacity------------ -----•- ❑ No. of compartments Size--------------- ----- q p• Disposal Fi� Distance from nearest well----...____--.._Distance from foundation___________________Distance to nearest lot line---------------._ ; ❑ Number o? lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type os filter material----------------------- Depth of filter material----------:-----------Total length-----------------------------•------------ /�/ Distance to nearest lot line.. ---... Seepage Pit: Distance to nearest well___.___`fDistance from undation------_ -- �� Depth__ I�Size: Diameter----- -- Number of pits.--__ -f--=-- ----Lining material__��__.�--------�- Cesspool: Distance from nearest well-------------___ Distance from foundation--------------------Lining material-..--.-_.________-_.______.__._----- 171 Size: Diameter---------------- -------- ----------Dept th----------------------------------------------------Liquid Capacity----------------------r-----9 Privy: Distance from nearest well.________----------------- ---------------------Distance from nearest builcling------------------------------------ ... ❑ Distance to nearest lot line ----------------------------- - ---------- ------ --- Remodeling and/or repairing [describe]------------------------- --------------------•-----•----••-------""-•- ----------------------------------------------•---------•----------•----------- I hereby certify tha# I have prepared this application and that the work will be done in accordance with San Joaquin Count • ordinances, State I .ws, and rules and regulations of the San Joaquin Local Health District. Si ned ------------ -------------------------------------•---------------------- --_." Lrnar and/or Contractor) -- -- - - t '� } ------------ - Title ------ { ) $Y� ' ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si a}. FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED BY_ - ---------- ------ ----- DATE----------------� -r--:S-----�-- ---------- DATE REVIEWED BY---------------------------------- BUILDING PERMIT ISSUED------------------------------------- DATE Alterations and/or recommendations--------------------------------------------- --------•--- ----- ------------------------------- --------------------------------------------- --- ----------------------------------- ------------------------ --- ------ 1/- y� _• Date.... - Y FINAL INSPECTION BY------------------- -------------------- --------- --- � SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Lodi, California Manteca, California Tracy. California Stockton, California ES-9-2M 10-52 Revised W-2100