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y APPLICATION FOR SANITATION PERMIT � Permit No. -- -- ---------�--- (Complete in Duplicate) "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. JOB ADDRESS AND LOCATION....... __ _ }_ /��i � ------- Phone- ------•--------------------------- Owner's Name------------------------- ----- 'i? I_ __�'+ .✓ -� ----------------------------------- ---- Address---------------- ----•---- �j7� Phone-`--------•-----------------------•-- Contractor's Name-------- -----•--�t`-'-sir '�--•------------------•---•---------------------------------------- a Installation will serve: Residence R--'Apartment House Commercial Trailer Court El El _; 11 ❑ imEl t �., -=------- Number of living units: .../-- Number of bedrooms ___f -_. _. Number of baths1___ tot size ____ :-Q__.....-- ------=-----•- Water Supply: Public system, Clmrnunity,sy.stem ❑, :Private ❑ Depth to Water Table .----._ ft. PP Y� r Character of soil to a depth of 3 feet: Sand El Gravel El ❑Sandy Loam Clay Loam ❑ Clay ❑ fAdobe9 6.d Pan ❑ ew Construction: Yes Previous Application Made: Yes El Previous [ � 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--------- from foundation-------------------Material---------------------------.A,__-.------------- - ` No. of compartments-----------------------S''sze---------------------------------Liquid depth Capacity.j.•;=r is ' ! -/ ��:--- ._.Distance to nearest lot line-_..�_'�_.______._ J� Disposal Field: Distance from nearest-well.4/^. _._.Distance from foundation �y --Len th of each line___•--u3-�- r --------Width of trench----x-54 --=----- •--------- 6J Number of lines---------- -- - - 9 a vr Total length ,. = Type of filter material-_-<r -----Depth of filter material-_-.-/.7-____-_ g Seepage Pit: Distance to nearest well_------------------=-Distance from foundation--------------------Distance to nearest lot line-'_y_____.--_-- I ❑ Number of pits------ ---------------Lining material.----------------- Size: Diameter - Depth - q Cesspool: Distance from nearest well------------- .`-Distance from foundation----------------_-.Lining material--.--.---_._------.._.�:__.________. L'+Liquid Capacity gals. Size: Diameter_. --`----- - -------- ---- ":.- --- --Depth--------------------------------------------- --- q P Y- ----------------=_--y..-- ----------- ------------- ---Privy: Distance from nearest well------------ ----------------------------- ---- Distance from nearestbuilding ------------ 0 ❑ Distance to nearest lot line------------ -------- ! Remodeling and/or repairing (describe):--------------------- ------ ' --- --- ----- - F - . , �c -- ----------- ? _= - - - ------ - -- -- - - -- ---- - ---- - ----------- ! hereby certify that I have prepared 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. < (Owner and/or Co (Signed) ntractor) - _. _`-_ - - - [Title)_--- ------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----- -'_'_----~ !-------------- --------------- ----•-- - APPLICATION ACCEPTED BY---------------------------------- -------------------- ------ DATE-------------------- - -- ---------------- REVIEWEDBY-------------------------------- ------------------ ------------------ ---- ----------- DATE-----------_-•---•------- -- BUILDING PERMIT ISSUED------------- ------------ ------- - -----------------------•------------------------- - ---------------------------- Alterations and/or recommendations:--------------------- -------- ----------- ------------------------------------------------------ -------- ------- ---- ----------------------- - •--- -•----••------------------ Date--------------------- FINAL INSPECTION BY..._.. - ------------ ------------------ ----------- rq SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 30D West Oak Street y Manteca, California Tracy, California Stockton, California Lodi, California f Y E:s--e-2M 14!446 ATWOUo 12.54 '