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f may , 9 o APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 Date Issued Application is hereby-made to thF San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanceo. 549. l 4 r r o JOB ADDRESS AND LOCATION--- �I . Owner's Name....Al--- Address -�& --------------- --••---------------------------------------------------------•---------------------------•-•----_ Contractor's Name• "' , -- _�+_ _ !'l � ----------------------------- ---------------- Phone- .e_ - _ ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other n fi Number of living units: ___-- , Number of bedrooms -3--- Number of baths ___!___ Lot size ----- --- _' -f��_______._____._ Water Supply: Public system [❑ Commuriity system ❑ Private "C Depth to Water Table(" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑' Clay ❑ Adobe Hardpan El Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ g 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-�p-4-___Distance from foundation___za---..____.Material___-17,: - :. ------ ` [ No. of compartments..___------- -----Size----'3_XSX-------Liquid clef th----19_..............-Capacity---- �1-0------ i Disposal Field: Distance from nearest well. __------ Distance from foundation__/0_________Distance to nearest lot line- - i ( Number of lines______________ Length of each line_______'f�9""-�_„ __-_Width of trench �__ k_____._____---- s�� Type of filter material---- -A. -.---Depth of filter material----/F$'--_--------Total lengt€�--------14P----------------------- Senep Distance to nearest well---10.4------------ Distance from foundation_ o..-+____.-_.Distan e to nearest lot line--65------------ ® Number of pits--____,-_______-Lining material__],s_C_�'_------Size: Diameter_____ _-1(--- --------Depth------A/------------------------ Cesspool: e th----- CesspooL• Distance from nearest well-----------------Distance from foundation------------- ---___Lining:material_-__ ❑ = J --_-_ Size: Dameter---------------------- Depth -=1 -------------------------- als_..--- - - Li aid Ca acity----------------------------g 0 1 Privy:y�p - - Distance from nearest well _______________---------------------------------Distance from nearest building.____._____--______________________-_--_ I ❑ Distance to nearest lot line-------- - ------------------------------------- s 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 _ a. J aquin Local Health District. ordinances, t to aws, and .ales and regulationsofthe San 5ined)- �i ................................. ------------------;------------ (Owner and/or Contract` BY: ------------------------------ (Title)------- ----- --------- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed onreverse si e. i 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ ----------------- DATE---------------------------------- -- ----- I REVIEWED BY ------------- -------------- ---------------- --------------------------------------.- DATE ------------ - BUILDING PERMIT ISSUED -------------------------------------------------------- DATE --- l Alterations and/or recommendations:_______. - ____ - ------------------------ ----------------------------------------------------------------•------- -- •----------------•------------------- CX_,__6�4r ------ - ---- ------ •-------•--- •---------- C/-- ----------- -------------------------------------------------------------------------------------------- - ------------------------------------------------ -------------------------------- ------------- --------------------•------- FINAL INSPECTION BY:------- ---- ------ ------- -------------” Date------. l --- -- --------------------------------------------- SAN JOAQUIN LO AL HEALTH DISTRICT f Street n c er 130 South AmiaStt 'f { 300 West Oak S+naafi 132 Sycamore Street 814 North "C" $treat j Stack+on, California Lodi, California Manteca, California Tracy, California. ES-7-2M Revised 1.57 F.P.CO- K.:rte* +, *