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S1Permit No. ... G_��_.____ APPLICATION FOR SANITATION PERMIT, (Complete in Duplicate) /b k /rL p ) Date Issued ----_�.--` 1 Applical�ion is hereby made to the San Joaquin Local Health District for a permit to constructs d ' fall th work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-..Z---J --------- Phone-----------------------•----------- ---------------- J` ------------- -------------- -� Name------ ------------------------------------- Address.. --- ------------------------------------ Address.. Phone- - r Contractor's Name------ - ---------- Installation will serve: Residence aL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: , Number of bedrooms -------- Number of baths ..,.^;—,-,-Lot size ---4 -------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth-to Wafter Table 'eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes 00--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- Y.__Distance from found ion--.-"- a. ----.Mater --- G -------- No. of compartments-------- .-""-----.--Size-- +r- --- --•------- iquid depth_ ....- -- . CapacifY � Disposal Field: Distance from nearest well.................Distance from foundation-----------------...Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of french-------------------------------- - of filter material-------------------------Depth of filter material--.--- -- ------- c----Total length----_-___--_--_-.-------"----10 - Seepage Pit: Distance to nearest well-.-f-, _l--Distance f om f. undation-_ .G?---------Distance p nearest lot line_ a'F--_- Linin material". - ,fameter------0 Depfh.-. �--------------- C Number of pits. ..-�sy- g ) Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining sial gals. C� Size: Diameter------------------------------------Depth--------------------- •----- ----------- -------- aing Capacity tY- ------------------------ Privy: Distance from nearest well----------------------------------- --- ------- Distance from nearesf building------------------------------------------ Q ❑ to nearest lot line----- ---------•----------------------------------------- Distance _-._- -__-_. ----------•--------------_-.---._._ r r Remodeling and/or repairing (describe)------------------------------------------- -•---------------------------•----------------------- ----------•--------------- �V -..- -..._....--_•-•-•_•--------••-------------•---•--_--------_•__-_-_---_---_-•-----••---••-----'--------------•_--__-•-----_----__-_---_-_----•----•------•---_-_---•_--------•--••------------------•------------ I hereby certify .t4a3 I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aw •and rules and regulations of the San Joaquin Local Health District. ----------------{Owner and/or Contractor) Si r`se (Title)----- .- �------- By: .... . (Plot pian, s awing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE-----` - -- APPLICATIONACCEPTED BY------------------------ --- ------------ -- --------------------------- - 'Cr-------------- -------------- REVIEWED BY--------------------------------- --------- ------ ----------------- --------------------------- ----- DATE---------- �- --•--- - BUIL.DING PERMIT ISSUED--------------------------- DATE - --- --- �---------•---------•---------•---- ------ y Alterations and/or recommendations:----- --------- - --- - -- - --------------".-----••------------------------------------ ---------------•------- ---- - • - ------------�------------• - - --- ------ - F-- - -- -_. �- ---------- -- ------------------------------------------------ FINAL INSPECTION BY------ ------------------------------------ Date-------/--a... ---- -- -----•-•- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+Oak Street 132 Sycamore Street 814 North "C" Street 130 South American 5+raet TracCalifornia Stock+on, California Lodi, California Manteca, California y. ES�9 145446 AT W OOO