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✓ I APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 Date Issued .____�� Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .ter JOB ADDRESS AND OCA 10 __ ._Q._ _ _______.ZV� -_-.. Owner's Nam s _ . -- - -------- -------- Address Contracto NX Name_______________ _______ _ ---------------- Phone_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /----`Number of loedroomso?___ Number of baths _/-___ Lot size . ' ---------------.-____________-_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa X Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Not' New Construction: Yex 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-- Distance from foundation_ __ �� Materi -- - --------- ----- No. of compartments„,,�__ ___----------Siz _ _� - 1 Liquid depth_ _ Disl Field: Distance from nearest weil_�Q--_1-__Distance from foundation___�Q____._.Distance to nearest lot lire_____, posa ----- Number of lines______________________ Length of each line/,�_d_�._�__-_______.Width of french_______�________._____-_-____ Type of filter material_ _ ____ . Depth of filter material____ ___ __11#1_______Total length____..._.: 4 /�d D r 0 *i Seepage Pit: Distance to nearest well .�00-v____Distan�-- -"."'S-if6—Diameter_-� dation__/��:.::_.Distance toneaFestWlot ine,,_ '} Number of `its - ""L'irin -materia �- -_ 9 esspool: Distance from nearest well-------------- ---Distance from foundation--------------------Lining material-------------------------------___ -_ D ❑ Size: Diameter--------------------------------------- epth------------------------------------- -------------Liquid Capacity_------------------------- gals. Privy: Distance from nearest well---::------------------------------------------,._Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------ -= Q -------------•------------------------------ Remodeling and/or repairing (describe):__ E ---------------•-•--..-._...---••---------------------------------------------- �f --•-•----• ----•-------------------------------••------- -•-----• -•------------------------------- ti ----------------------------------------------------------------------------------------------------------------------------------------- ._....-----------•-----------------•-------•----•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State] and ruleE'and regulations of the San Joaquin Local Health District. (Signed)............. ..... ..... ti- i - -- ----------- --------------------r--- [Owner and/or Contractor] +- ------ (Title)--- —=m. (Plot plan, showing size of lot, ocation o{ System in relation to wells, buildings, etc., can be pla6don.�reverse side). FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY--------------- ”' ---------- REVIEWED BY--------------------------------------------.-- -- . - • DATE --- ��---"----i . BUILDING PERMIT ISSUED-------------- ------ -------------------------------------------- ---------------------------------• DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------ -------•-----------------------------------� .-------------------------••-------------------------- �G .�-- a-------------•--•-----...-•----------------------------------------r-{ ---------------------------•---------------------- -- -------:---------------------------------------------------------- ----------------------------------------------------------------------•---------------------- -FINAL INSPECTION BY:.-___.____--_: '•____-- ` ' -n- - -------- Date-- -------------•--- � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SOCA American Stree+ - 300 West Oak Street 132 Sycamore Street 814 North "C' Street ,Sfoekton",> California '`�� Lodi, California Manteca, California Tracy, California ed W-2100 ' :-t 4