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1 APPLICATION FOR SANITATION PERMIT Permit No. _ i--3..----- ' 1 (Complete in Duplicated Date Issued -------- -� �Appfcafiion is hereby made to the San Joaquin Local Health Disfi ict for a permit to construct and install the work herein described.. This application is made in compliance with County Ordinance o. 549. ® '® `! ==-'-"'- 111 --------------------------------- JOB ADDRESS AND LOCATION---------��1_.-_.-/__1_-_ 1 r �-- `��r Owner s Name------------•---•---------•----•----•---• - - -'�-�---------------- -4-- - ------ ---------- ------� Phone-- ----�--- ---y-�-----•--- Address - --------------_..... ---- -•-----------------------------------••---------- ----------- Contractor's Name---- -----------------------•---••------•----- �-------- ---------------------------------------------- Phone--? X4'-4+------------ Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ElMotel E] Other ❑ [ Number of living units: _,/--_ Number of bedrooms' Number of baths . Lot size Cl- r - -`1 Depth to Water Table ------- _ _4 ft. Water Supply: Public system ,I� Community system ❑ Private ❑ PAdob Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cl Loam ❑ Clay ❑ e. P ❑ Previous Application Made: Yes ❑ Nof< New Construction: Yes ❑ No ❑� PP je� R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 244feet.) �t �4.----• ----Material Septic Tank: Distance from nearest well-69tr __Distance from foundation__ -- _ �r Ir No. of cor^partments-. :------- � _ ------Liquid dep lr.__s�-^a-`r-------Capacity- -90.7 ---- Disposal Field: Distance from nearest ail- -.-.Distance from foundation__J,r�-._--_.Distance to nearest lot line---C©_ - ---Len th of each line__ io- ------:.Width of trench--- 5ss Number of lines l 9 Type of filter material x _ ��-----Depth of filter material-- _f---.--------Total length- ."" ----- i Seepage Pit: Distance to nearest __--Distance fro foundation---f4---_ _____.Distance to nearest 1o�,1•sne-- ----------- ......De th --S- �------------ Number of pits-------�------__----Lining material_ -_��_..Size: Diameter----.133."j- P Ces ol: Distance from nearest well-__-------------Distanc o foundation--------------------Lining material---------------._------------__------ { ---Li Liquid Capacity----------------------------gals. ❑ Size: Diameter-------------------------- ----------Depth ---------------------------- --------------------------- Privy: =--- ---------- --- - G P Y Privy: Distance from nearest well-----------------------------'----- ----------Distance from nearest building---_--------- Distance to nearest lot line•------------------------------------------------------------ --------------------------------------- i. Rem ------------------------------- El Remodeling and/or repairing (describe):------------------------------ ------------------ ---------------- -------------------------------------- ------------------------ ----------------•--------=---•--------•----------•-------------------------- I hereby erci y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 4'- js, and rules and reg lations of the San Joaquin Local Heal+h District. �� _ [Owner and/or Contractor) Si ned }- - --- --- = ------(Title)------ --------------- [Plot pian, showing size of lot, cation of system in rela ion to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ------------------------------- -------------------- -------------------- '?------- DATE_�-----•-------------------------------------------- REVIEWED BY ------------------------------------------------ --------- DATE---. -----------• DATE--------- - BUILD1NG PERMIT ISSUED------ ----------------------------------- � - -------------------- Alteration - ----- Alterations and/or recammen atians-----------------------------�-�------ --------------- -- --------------------------------- ----------------------------------------------------------- FINAL INSPECTION BY------------- -------�- '-------------- Date---- ' �'` ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street M-90 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M io-52 Revised W-21DD