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/4. 3 e `. J APPLICATION FOR SANITATION PERMIT /Per it /D 3Cf — s oL � �_ - �/ (Complete in Duplicate) p !� Date Issued .____ Application 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 Ordinance No. 549. JOB ADDRESS AND LOCATION . --_�/-- �_- .�,�/� Owner's Name-------- � _-.4 -----�--/-------------------- ---- --- +. ---- -- ---- - - -- - -�---- - -------- Phone--!`�`__=--�_+�--��- Address_-•-------- •-- __ u•." f "lf ;. - '----------------------------•- -- -----------•------------ Contracaar s Name -------•-------------------- Phone--- _- `s�Q Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other,X Number of living units: __/__ Number of bedrooms -I - Number of baths -__� Lot size Water 'Supply: Public system,K Community system ❑ Private ❑ Depth to Water Table _.$/Wft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.W Hardpan ❑ Previous Application Made: Yes ❑ No J9 New Construction: Yes ❑ No Ej 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 _______.____ ---------- E ElNo. 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 s Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ .V Pit: Distance to nearest well--- _ 07%4)-----Distance and tion-_ � -- g �� _sT___________.Distance to nearest lot line________.__ Number of pits_____/_______-_„Linin material______ _____ e: Diameter-----Ax2"r-__-_.Depth-._ '9_•- ----------------- G?__ r Cesspool: Distance from nearest well----------------- from foundation---------------_____Lining material-_-_-______-____-.._______ El Size: Diameter--------------------------- ------Depth_-.•------------ ------------Liquid Capacity------------------ ---- ----- ----------------- Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building_____-____-_._______ ❑ Distance to nearest lot line--- ----------------- ----------------- -----------------••-------•-------------- Remodeling and/or repairing (describe)____________________________ -_ -----------•--- - I hereby ce �fy t t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws and ru es andlr gulations of the San Joaquin Local Health District. l (Signed)------------- - ------- - ------- - ------- ------------------------------------- - � -- - : Contractor) By.-,_-------------------------------•------- , --- �---- ---- ------------ - -------Title)- ------ --- ot plana, showing size of lot, location of system in ;on to wells, bu' Ing etc., can be placed on reverse side). -,,,'F, DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - -- ------------ ------ DATE_�= REVIEWED BY--------------- y -- --------------------------------- - ----- ------ ------------- ------ DATE BUILDINGPERMIT ISSUED ------------ ----------------- ------------------------------ti. DATE - - -------------- - Alterations and/or recommendations-------------------- -- ----------------------------- --------------------------------------------------------------- ---------------------------- FINAL INSPECTION BY:- -1 - --------- Date--- ---� ~ _.�6 -d — 'y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9---2M 8-5I Revised W-2100