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APPLICATION FOR SANITATION PERMIT Permit No. .'�a- S (Complete in Duplicate) Date Issued App cat is hereby made_to the San Joaquin Local Health District for a permit to construct and install the work h This application is made in compliance with County Ordinance No. 549. f�O$_ 2 77 O T4Z herein described, JOB ADDRESS AND{LOCATION- b� JW 4 /!/� T�tA at.,- ---Name-.. ------- - ..... ------- ----------------------------- Phone --------------- Address - e �y � � � -----,, ---77--- Contractor's Name----- Yi1 •---•--••-------- - - -, Installation will serve: Residence Apartment House ❑ Commercial ------ Phone Installation of livingunits: _______ Number of bedrooms �' Trailer Court ❑ Motel Other ❑ - �_-- Number of baths"_______ Lot size _ Water Supply: Public system [] Community system ❑ Private Depth to Water Table f Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Q ft, r`a .5 ❑ Y ❑' Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes No 0 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 --_.._Distan o from foundation_- (� No. of compartments______ -Material___ ------ -- --- _ ------- Distance Disposal Field: from nearest well____ �� Liquid depth_-.--" ..1 „-----;Capacity------------- Distance fro oundation___.. d Distance to nearest lot li e_---/ SF Number ofXliries- --- ----------------- - Length of each line-------- ---- .-.Width of trench.? Type of filter ma erial� --- '_-_ © d + r,.. Depth of filter material____.__-4r-- ab Seepage Pit: w Z rr Total length--- --, ----Q---------_ -----) Distance to nearest well _ _______ _ D ' Z-r istance from,.foundation____________________Distance to nearest lot line___"_______"---_- . ❑ Number of p.its---------------- "----Lining material------------------------ Size: Diameter --------- ---------Depth---. Cesspool: Distance from nearest welly ---_-- ------ -. . __.Distance from foundation _ -_Sizes t f3iameter ,. .. .;� Lig i a. ��_ Depth._ atarial- ng m _ - --- Li uid CapaatY----- -�`�-------_g'as� Privy: Distance from nearest well "_--____-__--_ }----------_____Distance from nearesr building ❑ Distance to nearest lot line---------------- :- 9-------------------------------- Remodeling and/or repairing (describe)_______________ -- + --------------------- I -w yy --•--,--------•---------•-------•----------------------- - hereby -- - ti --- - -------------------------------------------- ---------"----•--------------•--------_---------------------------------------- � I hereby certify that I haveprepared this application and that the.work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f SS led) r ( 9 _ By; ------ - �------------------ «---------------------(o _ - caner and/or Contractor) ________________ (Title)------------------ --- - - (Plof plan, showing size of lot, location of system in relation to wells,'buildings, etc., can-be placed on reverse 'side). FOR DEPARTMENT USE ONLY �. � s APPLICATION ACCEPTED REVIEWEDBY. -------- --- ------------------------- ------------ I ---------- DATE--------------------- ----- --�-- --- ---- BUILDING PERMIT ISSUED------------ ----------------------------------- DATE_----- ---------- --------------------------- ____ ______ __ Alterations and/or recommendations:----"--"______ - DATE_ ------ --------- -------------- ----------- ---------------------------------- ------------------------------------ ----- ----------------------•--------------------------- �r ________________________ -------- ----- t NAL INSPECTION B ...__ - -_----- Date-------- -------- ---------------- --- 1 SAN JOAQUIN LOCAL H LTH DISTRICT VLM-f0-52--R0v;sad- merican $}ree} 300 Wes} Oak $+rae} 132 Sycamore Street 814 North "C" Street California Lodi, California Manteca, California Tracy, California W-2100 +