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1 Id SANITATION PERMIT Permit Na ` APPLICATION FOR .(Complete in Duplicate) Date Issue ---•--A plica{ion is hereby made to the San Joaquin,Local Health District for a permit to construct and install the work s bed. This application is made in compliance with County Ordinance No. 549. � 4 ------------ ----•---------- JOB ADDRESS AND LOCATION -- dry- -----••--------------- Phone------------------------------------ _Q= �- -s Owner's Name----------------•---- • - ------•------------•---------------- Address---------------------------------------------------------------------------- ---------- q C�• Contractor's Name-------------------- ----------• M_ el el ❑ Other ❑ Installation will serve: Residence ]N Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of living units: -------- Number of bedrooms - Number of baths ----I--- Lot size Water Supply: -Public system X Community system ❑ Private ❑ Depth to Water Table #57 ft. s Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe-P Hardpan ❑ I • Character of sail to a depth of 3 feet. ❑ ❑ y Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +anVor cesspool permitted if pub sewer is available within 200 feet.) i "31 V Septic Tank: Distance from nearest well-----------------Distance from foundation--- -�--p----.Materna_--___._--_ No. of compartments-- ------- Size x---y------- -----Liquid de th--------- L Capacity Dis aI Field: Distance from nearest well-- N- -.-.Distance from foundation-------Zp---------Distance to nearest lot line------S------ �y p Width of trench---------�2---` " -- --------;- Number of lines-----------I-----�----------------Length of each line-a-_v_-, Total length--_-___-- � a Type of filter material----- Depth of filter material------I�!------ i ... —� - Distance to nearest lot lin e----l-p--�-. -� istan-----------Deere----- f247 � r Seepage Pit: Distance to nearest well__, -�_�------,Distance f_ rorJj fo ndation_-_. GCS( _ __Size: Diameter__-. ' Number of pits.-_.--�--------------Lining material- Distance from nearest well-----------------Distance from foundation_-------------------Lining material_-..-,_.---------------------- gals. ------De th-------------- ---------------------------------- --Liquid Capacity----------------------------9 F1 Size: Diameter-------------------------- p ' Distance from nearest. building------------------------------------------ Privy:. Distance from.nearest well------------------ _ ------------ ❑ Distance to nearest lot ine-------------------------------------------- --------- ----- --------- I � i e -------------- ------- ------- - Remodeling and/or repairing (describe)--------------------- ----------------------------- 6 __ _______ -•---•-----•- 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. = ---- Owner and/or sTitle By:_------------------- ------------------------------ --------------------------------- buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot,-location of system in relation to wells, FOR DEPARTMENT USE ONLY DATE---------- --- ------ ---------------- APPLICATION ACCEPTED BY-----------, ------ --------- DATE------------------------------- REVIEWED BY------------------------- _ BUILDING PERMIT ISSUED -------------------------------------------------------------- --------------------------------------------------------I---------i------ i ATE.. :-_ ------ A -- - Alteratind f. r recommelatians:_- _ _ _ - - -------- --------- ----- .- meq, k_ ..:.--��. €�' �� ..� ----------------------- --: -( -------- --------------------- FINAL INSPECTION BY:.-=------- ------- ---ill_:. - Da+e----------------------------------------•----- ---------------------------- SAN JOAQUIN LOCAL°HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North •'C' Street 13o South American Street Manteca, California Tracy, California Stockton, California Lodi. California __ _ �_-•__J "I )Inn _