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'Of �irPPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate] 14 Date lssugd Appl'jcation is hereby made to the San Joaquin Local Health District for a permit to constructand install the work herein described. This application is made in compliance wfh Count OpOnance No. 549. JOB ADDRESS, A�D LOCATION______ ----- ---- ------ t - ...... ------ ----- -------- ------- ------------------------------------------------------------------ -------------------- Owner's Name-- --- ---------- -- -- ---------------- -------- -- Address---.-.z--- ------ _----- ------------------ - ------------- Contractor's Name--• ---- --1 ------------ - ------------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House F] Commercial F] Trailer Court E] Mptel L] Other 0 '> Number Number of living units: __4--- Number of bedrooms _cl� baths _1--- Lot size -----I ____________________________ Water Supply: Public system Ej Community system E] Private Number to Water Table ----------ft.---------------------- . I Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam FT Clay Loam El Clay El Adobe'Z-/Hardpan El Previous Application Made: Yes E] No E( New Construction: Yes ENo El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public�ewer is available within 200 feet.) Se nk: Distance from nearest well_(050-----Distance j�romjuTd -------Mal,e I_ ---------- --- - ------- --- �_N�Liquid depth------------ .-- --- -------- --- No. of compartments------------;Z�---- ------ ---------Capacity----- p -stance from found _4---- Dis field: Distance from nearest,weli 1= D foundation_5�T 4/_-Distance to nearest lot line --- -- ----- idth of trench_________Number of lines---- ---- -------- -Length of each line______________ ".Z 1'� W1 - ---------- --------------- Type of filter materiid,4'____,��_Gepth of filter material------LU-----------Total length---------- -------- Seepage Pit: Distance to nearest well_____________________Distance from foundation------ ----------...Distance to nearest lot line________....__.. El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------I El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------•-----------gals. ------ ----------- ---- -- ----- -- Privy: Distance from —--------------------------------Dis7an—ce—froi1n—neareff-b�u diF41---— El , Distance to nearest lot line-----------------------------------------------•-------------------•------•----------------------------------------------------------------- Remodelingand/or repairing (describel---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------..............-------------------------------------------------------------------I-------------------------------------------------------------I—--------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------,--------------------------------------------- -------------------------------------------------------------------------------------------------•------------------------------ --------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and rules "d regulations of the San Joaquin Local Health District. l ------ I—,---- --- -------------- -----------------------------------------------------------------------------(Owner and/or Contractor] (SignedL,e B :_ y --------- ---------- -------------------------------------------------- (Title) etc., can be placed on reverse side). ------ --------------- -----------(Title)--------------------------------------------------------------- (Plot plan, showing si of lot, locat o of system i relation to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- ---------------------- --------------------------- -------------------------------- DATE--��K_—--------------------------------- REVIEWEDBY-----------------------------1G---- - ------------------------------------------------------------------------------- DATE------ BUILDING PERMIT ISSUED----••---------------------------------- ---------------------- DATE Alterations and/or recommendations:-......... —47e--------- ------ ----------------I------------------------------------------ ------ ----- ------------------------------- ---------------------------- ----------- - 0,A4- t4 ��x d - -—- --------- 7� --------- ------------------------- Ze - - - ------ ---- ---------- -------------- ----------17----------------------------------------------------------------- ------ j--------------------------------------------------------- -------------- - ------ --------------I------ - -------- A� -----UA_ ----- --- ------- 3 Cl FINAL INSPECTION BY-------- ---------------------------------------------------- Date 9----------------------------------------- ---- ---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamoro Street 814 North "C" Streaf Siockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M 8.51 Revised W-2100