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--�- �^�-/- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) % .Date Issued-P/ ssued/P- --� 3 an Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the S This application is made in compliance with County Ordinance No. 549 4_ .' ---------- ----- -- ---------------------------------------- --- JOB ADDRESS AND LO ATlO - ------------ - Phone ---.----- -- ---- - - ------------- Owner s Name------- -----------------•--- --------.---- V---• •----•--- Address----•-•-----•---------- -------------- Phone----------------------------------- 4 --- - Contractor's Name ------------- ------ otel ❑ Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence p / `' ----- _-__--__---- 1--_- Number of baths -.�_-__ Lot size ---------- -- ---- Number of living units: -�---- Number oybydrooms Private ❑ Depth to Water Table_© ft. Water Supply: Public system U;--Community system ❑ Clay Loam [I Clay ❑ Adobe�ardpan [1]Character of sail to a depth of 3 feet: Sand [:] Gravel ❑ Y Sandy Loam ❑ e Previous Application Made: Yes ❑ No [ w Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / U ---Distance from fo dation_-/v-------- .Material----- Distance from nearest well- ' _Cal:acit : Septic Tank: - -5ixe_ �Y------Liquid depth.�-.IT. Y - =� No. of compartments._-- ��------ /4? _-Distance to nearest lot line.( ----- from foundation_. __- _. e 'Pr/ ._.Width of trench- _ -------- pisposal Field: Distance from nearest well Qength of each line--� �-. Number of lines-----1-------� _- --Total length-- -- Type of filter material_07WID�---- Depth of filter material Type ----------- Seepage Pit: Distance to nearest well------- ---Distance from foundSize:nDiameter_--Distance tonearestlot line-----.------• ❑ Number of pits-----------------=---Lining material_--------------- - ng material Cesspool: Distance from nearest well-------- -- -----Depth from foundation----_------------Lining Capacity-.._--_-_---___-.-- ----gals. ❑ Size: Diameter----------------------------- P Distance from nearesr building_-- -. ------------------------------.--, Privy: Distance from nearest well------------------------------ _____ ________ . Distance to nearest lot line_____-__-----___-- - Remodeling and/or repairing (describe):-------------------------------------- �^.—."-t--. ----- ------------- ---------------------------------------------- --------•------ �"_f----------- ----------------• ------------ ---------------•------------------------•------•-------------------------------------------------------I-- - ----•------------I-----------------•---------------------------------- ui -- ! hereby certify that I have prepared this application and that the v+ork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Lacal Health D--r— (0 (Owner and/or Contractor) 1 ---------------•----------------;-------------------------- Signed � `{' Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY ri - - ----------- DATE------- - ---------�- ------� - - APPLICATION ACCEPTED BYA- __xft1Z1 '�' 22 ---------- -- DATE �V------- REVIEWED BY------ •--------- DATE p--- ------------ - /�+ a 1. r1Y�1 BUILDING PERMIT ISSUED----- '�t--'e, ;. = ------------- Alterations and/or recommendations:-.-.------ f J --------•-- •--------------- --------D---a--t-e--------------j-------;--�------A--- - ---�-------- �-- --------- FINAL INSPECTION BY:. -- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT g�4 North "C" Street l32 Sycamore Street 130 South American Street 300 West Oak Street Tracy, California Lodi, California Manteca, California Stockton, California f 1. E5-9-2M 10-52 RBVISed W-2400