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APPLICATION FOR SANITATION PERMIT Permit No. ------p p--79-•-- (Complete in Duplicate) Date Issued b made to the San Joaquin Local Health District for a permit to construct and install the work herein described. } Application is hereby This application is.made in"compliant it C �unty Ord4 _0 e No. 549. ✓ � _f�� .------�-----' ---------------------- ---- JOB ADDRESS AN LOC TIO _ Phone.---------------------- Owner's NjTme-------- - ------- .5. ------ --- ------------ ----- - �----- .Address---lir ___ .- - --- Pone.. Contractor's Name-- ------------------- ---•---- -- ------ ---- Contractor's --------- --- otel Other ❑ artment Nouse ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence AP s� ----- { Number of living units: " --•._ Number of bedrooms -ht- Number o 'aths _�_____ Lot size .___ __. __ ------------------- ------------ - Community system ❑ Private Depth }° Water Table __ .";. ft. Water Supply: Public_system ❑ y Loam Clay ❑ Adobe ❑ Hardpan ❑ Gravel Sandy Loam ❑ Clay (� Character of soil to a depth of 3 feet: Sand ❑ ❑ No ❑ FHA/VA- Yes ❑ No El Construction: Yes ❑ � Previous Application Made: Yes F1 No ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ccesspool permitted if publiF sewer is available within 200 fee+p) r �� .Mater'sa! istance from foundation___ - Ca pacify_Septic an Distance from nearest weIIQ---- --- Liquid rdepth____---•------------ P Y !'"""" No. of compartments________________ f---- S, e-- j�7�LLr./ _stance from foundation __ __-_.__ __ istance #o nearest lot li�e��"-------------- Disposa ield: Distance from ares# w I Width of trench___.__---t _____ e �_ _-__ Length of each line__ 6_ - - Number of line. ---------- ---- - -- -- - g �. tl -------•---- ��--.� �� rt;_Uepth of filter material__ I Total length of filter maters - ,-- Seepage Pit: Distance to nearest well_-----"Linin material e from foundation Diameter_---Distance to nearest lot line----------------- Seepage --------------- ❑ Number of pits--------------------- g __ Cesspool: Distance from nearest well---------- from foundation-------------------Lining material gals. Depth -- q p ----------------- --------- ❑ Size: Diameter---�----- --- -- ------�- ------ - P Distance from nearest building------------------------------------------ earest well Privy: Distance from n -------- ---------------------------- ❑ Distance to nearest loft line......"-------------------------------------------------------------------- ` - -------------•---------------- ------•------- -------- Remodeling and/or repairing (describe)-______-____-___-_._ ------ II ---------------------------------,------------------------------------------------ -- -------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Y ordinances, State laws, and rules and regu),ptions of the San Joaquin Local Health District. J r - ---___(Owner and/or Contractor) (Signed) --- - - ------------------- ------ Tle --------------------------------------------- - ------------- - -------------------------------------------- a (plot plan, showing size.of lot, location of system in relation to i e. wells, buildings, etc., can be placed on reverse s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _- --- DATE - ---------------------------•------------------- DATE____ _ _____ --------------------------------------------- REVIEWED BY DATE --------------------------- BUILDING PERMIT ISSUED------------------------------ -- --------------- -- ----------------------- Alterations and/or recommendations: -------------------- ---------------------- - --------------- -•--•-- ------ •----------------- -- .`' "�' A --- ------------------------------------------------------------A ----- I - -------------------- --- ----------- FINAL INSPECTION -----------------------------------------------I------ ---=- -------------------- - ---•--•--- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North ,C" Street West Oak Street 132 Sycamore Street [30 South American Street Soo Manteca, California Tracy, California Lodi, California ^� Stockton, California �p, + ,•yt '� ` 1� °"' ^ ' 'j.ES-9-2M Pevisod`i�i•5.7�,F.P.CO. 4