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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) } �, Date Issued ---------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de This application is made in compliance with County Ordinance No. 549. scribed. JOB ADDRESS AND LOCATION-I----2' -- ------------------------------------------•------- --------------------.-------------- Owner's Name.___. --_ - _________ -------------- - ---- ---------.-. Phone----------- --- --------------------- - --------- A dress----------------•-----��n--- - ---•--------- - Contractor's Name........... ------------------------------------------------_--------- -------------------------- e ------2_epb y ¢r --vdo--------------------- ---------------- -------- --------•------- Phone----'y`-�-�/-Sz.7 L Installation will serve: Residence ----------- © Apartment House [] Commercial ❑ Trailer Court ❑ Motel El Other E]. Number of living units: __I__- Number.of bedrooms __ - Number of baths Lot size __- -)�.�(-_�Z,T�_ Water Supply: Public system EDCommuriit s stem ------------------- Y Y ❑ Private 14 Depth to Water Table __1Y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ Previous Application Made: Yes ❑1 No New Construction: Yes R No ❑ FHA/VA: Yes ❑ 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-------sS"ff----Distance from � _foundation____/n_---°- - Material-----�e �WO.aU® No. of compartments----.----2- ------------Size...... ------ -Liquid depfh,,_ `/ rC - ----_-_---:-- U ..�-------------- - city_.. )'Disposal Field: Distance from nearest well-._,5'0-------Distance from foundation---!Q-'---------pis}ante to nearest lot line__c3S!__- _ R) Number of lines--------- ____________________ engeach (a — Length of line_�O_---_� r .---- ,P�_.Width of trench-- ----2�(-"---------------- Type of filter material----=- off -------Depth of filter material-----•-J-9'---------Total - -1-9 �je—f4+: Distance to nearest well---,/go_' ____Distance from founclation__!�------------.Distance to nearest )of line_-✓ -------- ® Number of pits .--1_____-_____-Lining material___13 6- / -------Size: Diameter_ f'l-X--6------------Depth---.6------------------- Cesspool: Distance from nearest well________--.___- Distance from foundation_________________--Lining material_--___-____----------____--__ ❑ Size: Diameter------------ ----- - ------ ------------Depth_._-_-_----------------------- ---------------------Liquid. Capacity- ------------------ -------gals. V Privy: Distance from nearest well-------------------------------------------------- __-_---------- --------- -Distance from nearest buildin g l , EJ Distance to nearest lot line` \J Remodeling and/or repairing (describe):---------------------- -------------------------- ---- --------------- ---------------•----- --------------------- ----------------- -------------------------------------- --------------------•--------------- -- ---------------------------------------------------------------------------------------------------------•------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4 ordinances, State laws, and rules and`regulations of the San Joaquin Local Health District. (Signed)--------------- ---- •- � !i"�c-/------ --------- - --- -- --- --- ------ - ---------------------------------------(Owner and/or Contractor) By---------------------- --------•- (Title) C ............................... (Piot 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 REVIEWED BY------------------------------ --------------------- - --------------------------- - ---------- ------- ------------------- ------- - ------- �---- --------- ------- ------- BUILDING PERMIT ISSUED ------ DATE Alterations and/or recommendations-------- --------------------------------------------------------------------- ________.___----_ ------------ DATE. FINAL INSPECTION BY:---------- . _ ._ - - Date--------- �J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1300 West Oak Street 132 Sycamore Sfree! SfocEfon, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1-57 F.P.CO.