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APPLICATION FOR SANITATION PERMITPermit No. (Complete in Duplicate) Date Issued Appappl ca is hereby made to the San Joaquin Local Health District for a permit to construct and ins all the work herein described. f This application is made in compliance withCountyOrdinance No. 549. .Z�q .r JOB ADDRESS AND OCATION_-_ --- ¢ 5 1-14 9 Address- V------------- ------------------- Phone ---- ---" Contractor's Name 99 Gj ••M� ' - -----•---..---•---------•--••------••---•------- �. Installation will serve: Residence ------ Phone________ ❑ Apartment House ❑ Commercial [) Trailer Court ' Number of living units: �---_ ❑ Motel ❑ Other ❑ mber of bedrooms-_-- Number of baths _.i!_-- Lot size __.M_ __ r__�____ 1� r� Water Supply: Public system Communit system �� -X�--"--`--• Y Y Private ❑ Depth to Water Tablet- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamfiQ Clay Loam ❑ Clay El Adobe El Hardpan E3Previous Application Made: Yes ❑ L No 9 New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___i_►Jr ! istanceffrom f�undon_- ___--- Mate i�i.__�e ,.. � No, of compartments ,� Size_/� -/ ._Liquid depth-------- Disposal Field: Distance from nearest well_--_"--`_--_,Distance from foundation__ Capacity--- Disposal -[3_ ! ! Number of lines--_-_--_-_'rf �,.Dis Price to nearest lot line__.-5__-..----- Length of each line_- -_y L .r Type of filter material _ r. --- �' dth of trench----- - -- . _ Depth of filter material------�' ___ _-- ! Total length--------1 ------------------ -- Seepage Pit: Distance to nearest well___ _ ____Distance from foundation_____.___._ ❑ Number of pits---------------- materiale ---• Distance to nearest lot line__- ----__ ----- Lining -----------------------Size: Diameter---•-----------------Depth--------------------------------- 11 .---- -- --- -------------- -- Cesspool: Distance from nearest well_ ________Distance from foundaation___._-.--_- -------Lin Size: Diameter__________________ _ m material _ �.. = - :> Depth--:-: = ti4 .Liquid�Capaci#y-----------------------------'�- ---- -- ------------ ---- . ._ - .=_•_ Privy: Distance from nearest wellgals. �❑ - Distance from nearest building --- -----Distance to nearest lot line-';--------------------- ----------------- ------- - --------------------------------------------- Remodeling and/or repairing (describe):------- ---------------------------------------- --------------------- •---•--------------------------------•-------•---------------•--- I hereby certify that I have prepar"ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andel rulesAnd regulations of f he San Joaquin Local Health District. (Signed)- --------------------------- - t ---^---- --'-------------------"I� By--------------=---•-------•---------•---•-------•---•-------•---�_.-.------ -- - - - - _.._ - � r Contractor) : (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can b1e placed on reverse side). FO PART,MENT USE NLY APPLICATION ACCEPTED BY____.._ f REVIEWED BY r '`' ----- DATE l .�. _._. - - ----- -- ------------------ UILDING PERMIT ISSUED_ -�_-DATE------------------ Alterations and/or recommendations:.______-._ ------------------------------------ DATE---------------------- -- - --------------------- -------------------------------------- FINAL INSPECTION BY:_..____ -[10 -� ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street _ 132 Sycamore Scree+ e - S+ockton, California - -^ 814 No'r+h "C" Street Lod;, California. a=- Manteca California .:.. .-�.:.. r...-y.• -��_ '--�._ ."'� -•�-'� Tracy, California � ES 9=2M o-s2 Revised