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• ° x R SANITATION PERM APPLICATION I=0 IT Permit No. (Complete in Duplicate) Date issued _-- �- gpplica{ion is kiereby made to the"Sen 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. -� -2 i JOB ADDRESS AND LOCATIO _---- ----------------- Phone------------------------------------ -------- -------------- I Owner's Name---.---- - a Address , - ....._ ••-=------- `� _---- - .far -E'. one ------------------- Contractor's Name-------------- -- -- ----- ------ r e---Apartment House ❑ Commercial ❑ Trailer Court ❑ ;Motel ❑ Other r installation will serve: Residence �Ap f - --- Lot size,,�-_..�_�.��.�'`--•-------------- Number of living units: --�__. Number of bedrooms - . Number of baths .�- Private ❑ Depth to Water Table . T .t. Water Supply: Public system �ommunity system ❑ Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand r-1Gravel F1 Sandy Loam ElCIay.Loam ❑ Clay ❑ �R No ,}, .New Construction: Yes [] No '" Previous Application Made: Yes ❑ I"'S e . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material---------------------------•---••---•---- --•-=-� Sep ,Tank: Distance from nearest well_________________Distance from foundation-------------------- depth----------- ---------- .-Capacity No. of compartments--------------------------Size----------- Liquidf �; f,Q---_-___.Distance to nearest.l�t line......:........• Disposal field: Distance from nearest well__-..._Q-..-_-Distance from foundation_: N/idth of trench----- - -- ------------------- ^r Number of-4ines--------- --- Len th of each line_ .�1&--�----------- `- Depth of filter material___-- _ -----� Total length----- --- ------------ T e of filter material_ f"44 Type ! Distance to nearest lot line;_-4_------ Seepage Pit: Distance to nearest well... .---- ---Distance from foundation___ ______________ .re 1 f Size: Diameter__ Ar, Depth _-------- I Number of pits-------- ------ ----Lining material Cesspool: Distance f�•orri nearest well_______._____.__Distance from foundation_________..__.--Lining material----------------------------------- Liquid Capacity- gals. ❑ Size: Diameter-------------------------- Depth _--- _ _._.._Distance from nearest building------ ---------------•------------- \ Privy: Distance from nearest well------------------------------ -_--_-.__-_ Distance to nearest lot line----------------------------- 1 _..- --- - - -------------------- ---------------------------------------------------------------------- 0 -----------------------------•----- -- ❑ 1 ----------------- ---- -- -•--5 -------- -- Remodeling and/or repairing (describe):__-- V -----_•---------------____--___-_--- -----•-----•-- ---------------•-----------------------' ---------------•----•----------•------- ---------------.-- -------------------------------------------------- -- wo --------- - ------ - ----------------------------------------•-----•---•----- ---------- ---at.----------•--- -ii- -- e-- e in --cco 11 I hereby certify that 1 havespandared this a lli the San JoaquinhLocalkHeal heD r ct� accordance with San Joaquin Caunty ordinances, State laws, and rule 9 R� _Contractor -------------------- (Signed) ------------------- -----• A _..- -A ...... By:----------------------------------------- •--- -• -- buildings, etc., can be laced on reverse}� e. i (Plot plan, showing size of lot, locat�n of system in relation to wells, FOR DEPARTMENT USE ONLY ---- DATE-- -----`-------------------------- ---------- APPLICATION ACCEPTED ----------- --------------- ------ DATE--- --- ------- REVIEWED BY----------= ----- ----------- - ------ DATE.- =--- ---�------------- BUILDING PERMIT ISSUED. --- . --- ---------•------------------- ----- Alterations and/or recommendations:__--_-_------------------- I --------- ----- 11 Q ------------- --------------------••---•---••-------------•-----•---•------------------------------ f^� --•----•----•--------•--- --------------------------------------- -- ------------------------ --------------------------------------------------- iDate.--- ' - -------------------------------------- - ------------------- FINAL INSPECTION BY------------------ -------- --------------- - - , SAN JOAQUINYLOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California Es9 145446 ATWOQD n