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SII /K APPLICATION FOR SANITATION PERMIT Permit No. _ ?-------------------- (Complete in Duplicate) � Date Issued .-- ---r7.4�. 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. t JOB ADDRESS AN OCATI N--6- - -- -- ..Y---------- ----,----•-- Owner's Name-.--- ---- - ----------------- --------•--- ---- •------- --------- - - ------------------------------------ Phone----------------------..-.-.-----.-. Address----------- ----------------------------------------------- `� Contractor's Name--- ----------- ------------- -- -- --- ------------ ---------- ---------------------------------- Pho ----.-.-..17 ? Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --- Number of bedrooms �•-�`---- - -/.. ------�''.._ Number of living units: -- .1.�. Number of baths __ ---- Lot size .__ - _ Water Supply: Public system 49--"mmunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar pan ❑ Previous Application Made: Yes ❑ No lt--Wew Construction: Yes L ""E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well —Distance from foundation--_ _---.-_--.Material - --- -----------------_--.---. Size No. of compartments..___ -_ - ` 11(. O_.Liquid depth__ _ ----__-_--Capacity_____ d__-_-- Disposal Field: Distance from nearest well-4..o%#- ".Distance from foundation--j~-�---.Distance to nearest lot line---- -..----- �.•-� Number of lines-------- -..-..-�=--_AA-.- - Length of each line-_---_--J�-_"__-��-.----Width of trench---.U`4--------------------- Type of filter material---l. �(5. �`--Depth of filter material-_-_� _.-___-._Total length_--.._ --------------- ---------------- Seepage Pit: Distance to nearest wellll7M�'"- -__._Distance romp foundation_-.X�..�___r.�Dista Distance to nearest lot line-_/- Number of pits.----Z-------------Lining material_ !i,rl %ASize: Diameter-- %..(.-.....---__.Depth--..-' - ..-_-_---._-.-----_ (� Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material---.--__---.---.----._-----.--_._-_.-. `11 ❑ Size: Diameter--------------------------------------Depth----------------------- ----------- ----------------Liquid Capacity---------------------------- Privy: Distance from nearest well---- -------------------- --Distance from nearest building--------------_____----_------.------.-.-. ❑ Distance to nearest lot line---------------------------------------------------•-•------------••----•--------------------------------------------------------------------- Remodeling and/or repairing (describe):---- ---- ------------•-;•---f---=-------------------------------------------...--•------------•-------------....-----------•-••--------- -----------------------------------------------•---...-------------------------------------------------•--------------------------------------------•---------•------------------------------•-------------------------------- --------------•--------------------------- -------- - •--------------- - --------•------ -----•-------------•-------------------•-- •-------•-----------------••----- ----------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)---- - -- ------- --- ----- --------- ------ Ov r Contractors By:--- ------ -- -- ---------------------- -(Title)- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION( ACCEPTED BY------------------- -- --- --------------------------------------------------•------------ DATE------- '.-------- REVIEWED BY------------------------------------------- -- DATES--- --•-------- -- ------- ---------------------------------------------------------- - BUILDING PERMIT ISSUED------------------------- ----- ------ -----------------------------------------------------... DATE.--------- ----- Alterations and/or recommendations:.--------_--- -------- -- ------------------------------- - ---- -- ----------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ------ ------------------------------------------------------------ FINAL INSPECTION BY: Date -0 ----------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9^2M 145446 arwOno 12-54