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APPLICATION FOR SANITATION PERMIT Permit No. 33� U t Dd (Complete in plicae). r 'r JJ r Date Issued J Applicationisis hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This apE>licatiori is made in compliant wit C my Ordinance o. 549. JOB ADDRESS AN LOCATIONS ----(: G D-,/' "' -- ----'---------- r Owner's Name..... Pho e = - - Address--------- - ---------------' ----------------•-•--•-----------------•--------- ----•-------------------------------- Contractor's Name------------------ � .! -- Phone.........--------------- ------•- Installation will serve: Residence ❑]�jArart ent Hou re ❑ Commercial ❑ Trailer Court •Motel ❑ Other ❑ Number of living uniti.a'_'_ um r o bedrooms ---. — Nurryber of baths Lot size Water Supply: Public system ommunity system ❑ f riva'te Q Depth to Water�Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe p-Vardpan ❑ Previous Application Made: Yes ❑ No 8'—New Construction: Yes ❑ 1 No �NA/VA: Yes ❑ No ©.— 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---------------_--------------------------------- ❑ No. of compartments-----------------------Size--------------------------------Liquid depth---------_- --.-----Capacity-••.............__..... Disposal Field: Distance from nearest well-----------------Distance from foundation--------.-----------Distance to nearest lot line_________________ Number of lines----------------------------------Length of each line--:---------------------------Width of trench------•--------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-------- _.-__----_.__ _-_.Seepage Pit: Distance to nearest well--------- `_'_____Distance fr m f dation-___.-` ''.Distance to nearest lot line....5+. ----Linin material.... Size: Diameter---�?`.-- Depth---iti s = - [�^ Number of pits------'17-1-_._. g , esspy9oh Distance from nearest well-----------------Distance from foundation_-..__--_--__-__..Lining material_.______-..___.__-_---.----------- . ❑ +f Size: Diameter-----------------•--------------•...Depth--------------------------------------------------Liquid Capacity----------- ----------gals. +7 _--__-_.__..Distance from nearest buildin L Privy: distance from nearest well__.__.__..___..............�.._.__._ 9 CIS Distance to nearest lot line.---.- --------------- --------------------.............._.----•--- tt, ------•-----••--•-"----•--"-------------------------------••------------------------- • �Rembdeling and/or repairing describe):-------��--------- -- -• -- ►'� - •---------•--••-•-------------------------_---------- -•------••--------- •------- ------------ ------••---------------------------------- -----))---------------- F -- -----------------------'-- ----------••------------•------------------------•-------------------•----------------------------._-.--.----------•-••------------------------------------------------------------------------- I I hereby certify that 1 have prepared this application and•that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. E �- !.�/l.l "� ( Contractor} (Signed) ------- -- / -----------------------------------------(Title)--- Gi� o ...__r........ (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------.___-r-A7K---V`---•------------------------------------------------------- DATE---- -7- ------------ -_ REVIEWEDBY.---------------------------------- DATE............... -------------------------------------------- BUILDING PERMIT ISSUED-------------- ----- ---_ DATE--------------------------------------- --------------------- Alterations and/or r�,commendations: . - L— f L-_-_ -- , 1 __ .."....... ti-R-o,7 _ ..� • -------------------------- 1 ._..................................."___."-_-_--.___."_._..__--.._-..---__.__...__.__-----"__.__-...-..-_.---.--_-"___---__-----.__----._ ...................... .. _ _ _ _...........--_-_........___...._....•--_._.--_-_---.-_-_.-_-_-.---..____-----...-_.__-____--."__-_---_---_____--_____ II .............................................------------------..................... FINAL WSPECTION BY:. Date. 1-Q.__-_ .'7 ----------- ------•------------•---- 0 SAN JOAQUIN LOCAL HEALTH DISTRICT / ... 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street l �'3,% INI f V Manteca, Californi." � Tracy, California Stockton, California Lodi, California ES--9-2M Revisea 1.57 F.P.CO.