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APPLICATION FOR SANITATION PERMIT Permit No, 5---J� (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to constru d install the work ein described. This appli4afion is made in compliance with County Ordinance No. 549. �j -� rK(Gel)A `�_,2.6 , 4 JOB ,[ �`� , Au1 A[�l�KSS AND LOCATION l�` ^�1 = Owner's Name-------------------------------- -- til _�Y__ :`' -------------- Phone- Address-_-----= d..-: ' --------- . --------------- Contractor's Name_______________________•---_ ,. � Installation will serve: Residence V Apartment House E] Commercial El Trailer Court ❑ Motel ElOther El Number of living units: -------- Number of bedrooms __ _- Number of baths .__1___ Lot size __-_ _ f R - SSC /_F ------------ --- Wafter Supply: Public system ❑ Community system ❑ Private �K Depth to Water Table __7� ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Do Hardpan ❑ -{ Previous Application Made: Yes ❑ No R'4 New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' nn ,, J Septic Tank: Distance from nearest weil______ 0--_ Distance from foundation-----10-__-------Material_______--A4Ld No. of compartments_-.______.�---__---_Size----r_�_- --• - `{ Liquid depth 's �------.Capacity-------$.0-°--- ' Disposal Field: Distance from nearest well----_<Vf Distance from foundation______{)_ -----Distance to nearest lot line......... Number of lines----------------?ILength of each line--- ��_,tQ _ O_Widfh of french----------- Type of filter material-------1.J_�E Depth of filter material__.___Ar________-_-Total length--------- -___ ------------------- Seepage Pit: Distance to nearest well_____________________Distance from foundation___-_-_____________.Distance to nearest lot line_-_-.___________. ❑ Number of pits---------------------Lining material-----------------------Size: Diameter---------------------- Depth-- ------------------- esspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material------------------------------------ ❑ Size: Diameter-------------------------- ----------Depth------------------ Liciuid Capacity -------gals. Privy: Distance from nearest welL_________. -------------------------------------Distance.from nearest b0clin 9 Distance to nearest lof'line________________________ _ ---------------------------------------- i Remodeling and/or repairing (describe): --------------------- --------------•••------•-----------------------------------•------------• -------------- h �+ r _ ----•------------------•------------------------------------- ------------•------------•------------•---------------------------- -----------------------------= --------------------------------------------------------------------------------------------------------------------•--------------- { I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, State laws, hand rules and regulations of the San Joaquin Local Health District. (Signed) ------�►L.-_ - ----- - ---- ------- ---- a -- -- - ----------- ------------- -------------- �--------- ----------(Owner and/or Contractor) 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. REVIEWEDBY-------------------------------------------- -- - 43 6 ----------- UILDING PERMIT ISSUED---------------------------- _ - -------------- -------------------- DATE / - - • -----da s:-------------- - DATE Alterations and/or recommendations:,_.___-__-_._- --------------•-----------------------------------------------------•------------------------ --------------------------------------------- - -- ------------- ------------------------ - -- - - - ------------------------ FINAL INSPECTION BY:-------------i..---- ------------------------- Date---------------- ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ E14 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100