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A"LICATION FOR SANITATION PERMIT Permit No. - s- (Complete in Duplicate) -- � �., Date Issued f`�/9 s� ( Npplication is hereby made to the San Joaquin Local Health District for a permit to construct This application is made incompliance with County Ordinance N and install the work herein described. '"�-71 f 13 0. 549. JOB ADDRESS AND LOCATION ' Cerra - Ap-T7 of g Owner's Name------------ `" ee ----- l Address----•---------•-- - --------------- Phone Contractor's Name_ ------•----------------------- .._`__"".""•-•"_•__________ Installation will serve: Residence -- "-- -------------- Phone,__7_:_�6�. ❑ Apartment House ❑ Commercial p Trailer Court ❑ Motef ❑ Other Number of living units: -------- Number of bedrooms ---_�__ Number-of baths ----- ---Lot size Water Supply: Publics stem -- - ---. Y Community system ❑ Privateer Depth�to Water Table __-"-"_ ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe - Hardpan ❑ Previous Application Made: Yes ❑! No New Construction. Yes EDNo ' 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" "_Distance from foundation_" ------,Material---E-' .u��A 1 ( - No. o{ compartments -------- �i -------- ----------- ----Size" " '"_rC"_ r--Liquid depth--—-----------Capacity.�b- Disposal Field: Distance from nearest well '"! Distance from foundation""1o" } Distance to nearest lot line----7" Number oT lines-1-�------------- Length of each line__-X_OAp—---- ---------Width of french -" Type of filter material__1 -�'`+ __ :s ------ ----- .j " Depth of filter material- -----a----------Total length-.'-- -. - Seepage Pit: Distance to nearest well_-._--_"_--i'_--" Distance from foundation -------.-.Distance to nearest lot line------------------ ------- lumber of pits !r-_----------"Lining material----------------------- Size: Diameter- ------ ------- -----.Depth-----'--------------------- -----Cesspool: Distance from nearest well--------- " """ Distance from foundation--------------------Lining material....................... ❑ Size: Diameter---------------------------- ------Depth------------------------- - .............Liquid Capacity--- --------•--------------gals, Privy: Distance from nearest vrell"""._"__"_-__""-_"---_-"-_ -.-_--Distance from nearest building-------------------- ❑ Distance to nearest lot Remodeling and/or repairing describe ----------- ------------ --- --_" ` -------------- l . . - . �.� -, - t ---------•---------- ----- -- -- ------ ----------------------- I hereb certify that'I have preps --•---------------------------------------------- 4 Y Y red this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an les and regulatio s of'the San Joaquin Local Health District. (Signed)--- •-------- ------- "�+ . ------- By:----------------_---- -----BY=--------•--------•---- Contract ` t (Title) . (Plot plan, showing size of lot, location of system in relation to�w�lls, buildings, e} ,, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE_ REVIEWED BY - = UlLD1NG PERMIT ISSUED"""_ � - DATE_ Alterations and/or recommen ----------------------••------------- dations:_-."_".""-_""- - ` " DATE-_------- ----•------------ ---------------------------------------- - -------------------------------- -------------------------------------- ------------------------------- --------- FINAL INSPECTION BY:... ""-_"_. ' Date------ ��" ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" $tree+ Stock+ort, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100