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s I I7� Permit No. .._$."_}-.1 Y---• APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) _Date.Issued _____�!- Applica+ion is hereby made to the San Joaquin Local Health tnceiNoc 549.a permit to construct and install the work herein described. This application is made in compliance with County O ! [ .. . _......__._.._._._........__..l ................... J/ .JOB ADDRESS AND LOCATION ........ phone ---- Owner's Name.:__:l /'�Z�-.._ --•• ... ... ..---•-- :................ - J ' "Address... on cGl.� Contractor's Name----.. "_- "..- -.. -- .. ••• . ....... 11 Installation will serve: Residence P4.- Apartment House ❑ Commercial r-1• Trailer Court [I Motel F1 Other � A. X ice.--...---."......----.. Number of living units: J.... Number of bedrooms .�-Number of baths .... .. Lot size ..-__-�----• Depth to Water Table ....." ft. ❑ --- Water Supply: Public system Za Community system ❑ Private , m ❑ Clay ❑ Adobe Hardpan E]Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loom❑ Clay Loa Previous Application Made: Yes ❑ No New Construction: Yes g_No ❑ _ TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or fesspool permitted if public sewer is available within 200 feet.) Septic Te k i from nearest well________________Distance from foundation................----Material........................__.---------------------- ❑ filo. ----------------•- • Size.................. ------Liquid depth......... .•••--•-•••.._.Capacity..--•--•--•--• -------- compartments---- •• Disposal Field: ' 4-Distance from nearest well............._...Distance from foundation.......... •- Distance dth offitrenchest lot line....:....:::.:.:. Len th of each line-' .... -. ❑ bar of lines..._... -----... ...... .. . . g .".._._..-..Depth of filter meteriei_-__.----�.--- .....Total length-----..........................•----•-,- YPe o; filter material............. istance f om foun anon._ v• -•--.Distance to nearest lot line-- ....._ Seepage Pit: D;stance to nearest well..._�lfl ...... D � �ze: biometer. .-_ .�-----•Depth. ... -�. Number of pits. jZAJ--._--....Lining materi D:stance from nearest well_........... 'Distance from foundation__...:.... .- ---. Lining material_-_-__:_... ........ Cesspool: •:-_Li uid Capacitygals. ❑ Size: Diameter. ................. .••--- - .. p Distance from newest well......,_..__::_...__................ .•.- Distar,ce.from nearest building"- -.--_-__._. ----------------------- _. Privy: .... ... •••;_... ❑ - Distance to nearest lot ine::,...._..._................_ -_.".••-••----------"- •----•---•__ ..........................•-•--•- •...•-•-•-••. ..._..•-•...--•-•••- _ .. Remodeling and/or 'repairing (describe):_....-....•---.---- --.__................ ------......••--••....................... ...._.._............._......-__".._ ..- --- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanceySfate ; andrules and regulations of the San Joaquin Local Health District.._..._. ._....._._..'.._-� er an r ContractSi ned . _._....TS- --(Own d/oBy .- • - s - .(Plot plan, showing sae of lot, location of system in relation to_wells, buildings, etc., can be placed on reverse side .FOR DEPARTMENT USE ONLY :.......................... DATE. .- - '----- - . ............ -•.......... APPLICATION ACCEPTED B .............................. ............................. - DATE--- - -=--•--•--•----••-----------•-.---.._.. REVIEWED BY.----- --------- -- ..................................... ---- --------- --•---" ....:.__. --•---- DATE---------.. .. >�: BUILDING PERMIT ISSUED.. -•-••--••••-....... _ . ._......_. ............ Alterations end/or recommendations:_--..:_"....."..-. •-.••-- - ,.- ..................... ....... ..................••-- ........ - •-----.;� Date....:. :....... ... ...•-•.............. IO ........-: Fl AL INSPECT ,�.................. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wast Oak Street 132 Sycamore Street 114 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ,_cr_g 115N•AYw OCO r