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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica-1-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 Ordina ce No. 549. d -- JOB ADDRESS AND LOCA !O = ` Owner's Name -- -- -----•------------ Phoney __ ---------- Address.- _...._ � --- --"----------------'•--•----•-= ... . i Contractor's Name_____ ______________ Installation will serve. Residence A artment House Commercial Trailer' 'Court ❑ Motel ❑ Other ❑ • ' Com, p , ❑ - / i I Number of living units: _/---- Number of bedrooms __lumber of baths __f Lot size n__` ___+�-_ _ _________ ________________ Water Supply: Public system R4,OoCommlinity system ❑' Private ❑ Depth to Water-Table ________ ft. Character of soil fo a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy LoamE]f Clay L oam ❑ Clay ❑ Adobe lerdpan ❑ Previous Application Made: Yes ❑ No PRO'�New Construction: Yes [' No ❑F s TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within,200 feet.) ` Sep�tic Tank: Distance from nearest we}I -••Distance from found a1tion,_1_0r___* _--..Maferial Zsrsr*: ,/ -- -------------- E No. of compartments...-----. Size_ /. 0r __-___Liquid depth.9n6 ::__- C—apacitY____ I l► --Distance from foundatio . ( r�_--rte-Distance #o nearest lot Disposal Field: Distance from nearest wel Numberof lines___.__ r-______ 1___ ___ Length of each line _ __'_ ►� Width of trench _______..___________ of �� g Type or filter material__' '-- -------Depth of filter material__ .__)____,_±_--_Total lengfh__11 _A;- Pit: Distance to nearest well__----------------Distance from foundation------`-------------Distance to nearest lot line_____-_-____.---. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------•----------Dept h--------------------------------- Cesspool: Distance from,nearest well-----------------Distance from foundafiion--------------I-----Lining --------------------------------------- El . Size: Diameter------------------------- ------------Depth------------------------- --------------------i---Liquid Capacity gals. tjj Privy: Distance Brom nearest well_____________________ ____________________.__Distance from nearest buildin ,.. �. .....�._ 9�; ❑ Distance to nearest loft line----------------------------------------- ' " ` Remodeling and/or repairing"{describe)_____________________ ° -----------------------------------------••--••----------- ------------------------------•--------•------------------------ -._. .i . -------------------------------------------------------------------------------•-.------------------ -----------------------------•-.-•-.---.------------------.-.----------------------------------------------------------- -----------------------------------------------------------».________________________-___------___________.__-___________________.__.__--..____.._-..____________...._____________...______.__.___.___________I_. — I 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. (Signed)------ ?ir i i -------------------------------- ------"----------------•------------------------- ----- -------------{Owner and/or Contractor) -- Title-=---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed ori reverse side). FOR DEPARTMENT USE ONLY »a APPLICATION ACCEPTED BY---------- ---- --- ---- -- --------------------------------------------------------- DATE_ fr ------------------------ " REVIEWEDBY-------------------------------------------- -- - - -- -- -- ------------------- ------ ------ --------- ----- t ------------ BUILDING PERMIT ISSUED ------ ------------- - -7 DATE.--I ---- Alterations and/or recommendations:-------•-------------------------•------ ---------------------- -•--•-------•------- ----------------------- -------------------------------•--•----------------- ---------------------------------------------------_----------_____________________________________________________________ ___________________________________l-_____......-_.._._____..._.._.........._...........______ 1 _.________________________________________________________________________________-.--._--__._.._____________-.-_-____-__.______..__________-----__.-.-__._____.______________.-____________--___.__-_.--_._-__--__-__..__...-. r FINAL INSPECTION BY:- 4-_ .-•4------- ------- ---•--------------- bate__.: -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street r 300 West Oak Street 132 Sycamore Street 814 (,forth "C" Street Stoelton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100