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APPLICATION FOR SANITATION PERMIT dP (Complete in Duplicate) Permit No. _ I Application is hereby Date Issued _ _---2r made to the San Joaquin Locai Health District for a permit to construct and install the work herein 9 This application i made. in compliants with County Ordinance No. 549. r �-_1 erein described, JOB ADDRES AND LOCATION Rft aq t N _ p Owner's Name -•- -- ---------- 4Z - I f�ss�l o --- -- -�'"!�•�+r�•�. c^✓ ---------- Address. ................................................ - ------------------------- Phone Name_ .a y� --- ------------------------------------- Contractor's -- ------- -- - - -- - -�.1._d-a-- Insfallafion will! serve- Residence � � " t -- --------------- Phone---- Apartment House "--�""-"" ----" _ ❑ Commercial ��-------- -- Number of living units: _,/--- Number of bedrooms ❑ Trailer Court ❑ Motel ❑ Other ❑ Wafer Supply: Publics stem --- Number baths __�("__ Lot size ."_ / Y ❑ Community system k "--�" - - ❑ Private Depth of soil to a depth of 3 feet: Sand De th fo Water Table ,14A ft. Previews Application Made: Yes ❑ Gravel ❑ Sandy Loam ❑ NoConstruction: ❑ JClay Loam ❑ Clay [] Adobe Hardpan [] TYPE OF INSTALLATION AND SPECIFICATIONS.Construction: Yes (] No (No septic tank or cesspool permitted if public sewer is available within 200 feet. "N ) rpti( apk: Distance from nearest well-----------------Distance from foundation__"__ No. of compartments ,Material"- ----------------Size Liquid depth ------------------------ Dis osal Field; -------------------------- p Distance from nearest well_--6_Q` .Distance from foundati to e Capacity--------------------- Number of lines ------.Distance to nearest lot fine__ w�_ E tt Length of each line--- ` Type of filter material" �1" --�---- Width of trench"__,PV/ �-- ------Depth of filter material-----_ 1�� ----------------- Seepage Pit; Distance to nearest well"--- _!_"" "" Distant fr f ndafion___ r-----Total fengfh3 ------------ ' - •-- Number of pits------/"- ""___-_Lining material p ;, A� .__ ,__.Distanco to nearest lot lme-_ --"-- Cess ool: Size: Diameter"_ �" De th__-_ p" ' Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material______________"____- I Size: Diameter--------------------------------------Depth--------------------- - I �__I riv Liquid Capacity----------------- ,, Y= Distance from nearest well------------------------------------------------- -------gals. Distance from nearest buildin ❑ Distance to nearest !of line-----------------"---- g---_"--------___---- ------ ------- ----------------------------------- _ _ Remodeling and/or repairing (describe):____-________ --"----------------------------------•---------------"-- -------------•--------------------------------------------- ------------------------"----•------------------------------- - ---- ----------------------------------------- • --------------------------------------------------------------------------------------------------------------------•--------------------------- ! hereby certify that I a prepared this lica,0 and that the work will be done in accordance with San ordinances, Sfa /la , an r es and regula ns of fh San Joaquin Local Health District. Joaquin County .� ! (Signed)--- ,t -------- ------------------- - ----------------------- Tifle--- Contract �� "/MLS o'r)w (Plot plan, s 'ng size of lot, location f system in relation to wells, buildings, efc,, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B __ REVIEWED BY ------- = DATE BUILDING PERMIT ISSUED--- DATE------��------•- ---------•-------------------------------------------------- -----------------------------•------- terations and/or recommendations:---.. A E --- ---- ------------ = - --------------- ---- ------=-------------- .. -_ k �� " r ] ------------------------------------ -------------- "----"----- ---------- ----`-' -- --------'---_--` r- FINAL INSPECTION BY: •_" _ Date - SAN JOAQUIN LOCAL HEALTH DISTRICT . 130 South American 5tree+ 300 Wes+ Oak Stree+ S+ock+on, California 132 Sycamore Street 814 North "C" Lodi, California Manteca, California Stree+ ES-9-2M 8.51 Revised W-2100 Tracy, California