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� � Permit No. - - �APPLICAT40N FOR SANITATION PERMIT (Complete in Duplicate) Date issueddr� hereby made to the San Joaquin Local Health Distri ct for a permit to construct and install the work herein described. Application is This application is made in compliance with County Ordinance No. 549. - - -----------------•----- JOB ADDRESS AND CAN-- --------- Owner's ......... Phone ��- ----------- Name___ _.___ -•-�------ R ------------------ ---------- ---- - ---- - ----------- �---------- ---- ------------ Address__ Phone.- ---------- Address - -------------------- --- - Other Contractor's Name__________________________ Trailer Court ❑ Motel ❑ Installation will serve: Residence Apartment House ❑ Commercia4 ❑ �J �� Lot size . Number of living units: _a=Number of bedrooms _- Private �}e bar °f hto Water Table y� ft- Water Supply: Public system ❑ Community system ❑ [2--"DepthCls Adobe Hardpan ❑ Gravel ❑ Sandy Loam ❑ ;�Z n ❑ Y ❑ Character of soil to a depth of 3 feet: Sand E] ew Construction: Yes ❑ No /VA- Yes ❑ No ❑ Previous Application Made:4Yes El. No L+�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Material___________-----��1-------------------------- Li Liquid depth------------------------- Capacity #i nk:, Distance from nearest well-----------------Distance from foundation --------______ . q NO. of compartments--------------------- - 1Ze / Distance to nearest lot"line---. --------- Width of trench-- ---y---�-y F Disposal Fir d: Distance from nearest well--- from foundation-___ __d------ Number of lines------------ ---- Length of each line------- Q %i---Total length_---------------- 1g--------------- cnl Type of filter material r�--- -.Depth of filter material_--_.�k----- -- Distance to nearest well__-_____------- Distance from foundSizienDiameter__--Distance-toDneepptest lot iine----.------ a _Lining materia Number of pits------------ ` Distance from+nearest well----------------Distance from foundation--------------------- Liquid Capacity_.___ ----- ------ ----- gals. esspool: V ❑ Size: Diameter_______________________ _. DepthDistance from nearest building Privy: Distance from nearest well------------------------- - -------------------------- Distance to nearest lot line----------------------------------------------------------------------------------- 0 ------ \ ❑ n and or repairing (describe):1 --------•--•--------------------------------- --•- --------------------:------ --------------------=---• --------- ---- ------------------------------ ---------------------- Rem # ------ - I --------- ------------------------------------------------------- --------------------- -------------------------------------------•----•------- ------ ------------------------------------ ------ --- - -- --------------------------- - -hat - --- --i-- ---- I hereby certify that I haves prepared this application San Joaquin hLacalkHeall heDistrl�}n accordance with San Joaquin County ordinan es, $} }e lis, and rules and regulations o caner and/or Contractor) - - ------------ ------ --- ----- Si ned ------------ --- ( 9 �----•----- ------------- -Title)---------- -- ---�------------------------ ----- -------- I - BY�-------------------•-- - laced on reverse side}. (Plot plan, showing size of lot, location of system in relation to wells i ngs, etc., can e FOR DEPARTM T USE ONLY b ---D------------ -DATE- ----3_--3--- ---- APPLICATION ACCEPTED BY______--- ---a-- ---'- -- -----_- DATE_.___------•------------- --------------------------------- REVIEWEDBY-------------------------------------------- --� -` ----•----- - - SUILDWG PERMIT ISSUED_------•----------------------------------------- ------------- -------------------------------- ------ ---- ---------------.--.--.--.--.- --- ---- yy -- , Alterations and/or recommendations: - �. .. -- -- '---- �----- ----------- --- --- --------------------------- --------------------------- ----------------------- --------------------- Date - ------------------------------------------------------ ---- ----------------- --- -- --------------------------- ------------------------------- FINAL INSPECTION BY =- '----- ----- ---------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street 300 West Oak Street Tracy, California !30 South American Street Lodi, California Manteca, California Stockton, California ES-7-2M Revises 1.57 F-P.CO.