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Perm N .f^}^~"'- 1 o. 'l APPLICATION FOR SANITATION PERMIT C j (Complete 1n Duplicate) Date Issued __-� -- L hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is her y This applicatiori.is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OC ON--- _.__r�-_ `-,-- ---- -- -----------------------------------------------------------•-- t. Phone r -------------- Owner's Name_ -------- ------•---------------- s ------------- _ ---------- ------- - ------------------- -- Address------------` ------------ --------- Contractor's Name---------- -------- Other � � Motel Other ❑� f artment House ❑ Commercial ❑ Trailer Court❑ o ❑ Installation will se e: Residence Ap --------------------- Number "" "__"""--""._"""_ -- Lot size -----6 6----�--�? { Number of,living units Number of bedrooms __-�f Number of baths _ _- I } ' Depth to Water Table C�ft. Water Supply: '-Public system ,I� Community system ❑ Private ❑ p Adobe[I Hardpan ❑ Character of soil to a depth of 3 feet:_ Sand ❑ Gravel El Sandy Loam'M Clay Loam [ICla 0 No [:1Previous Application Made: Yes ❑ No, New Construction: Yes ` No E] FHA/VA Yes TYPE OF INSTAL�L-ATION,AND SPECIFICATIONS: wi#hin 200 fat.) No septic'fank ar`cesspool permitted if public sewer is available Septic Tank: Distance -from,nea nearest well`-------------=--DZ�ance from founds--Liquid depth--Maierial--------__Capacity_.______ �.------ ❑ No. of compartme •3�. 1 _—_Distance from foundati --"7 -Distance to nearest lot line__-"--.----___. Disposal Field: Distance fromnearest well.,_ _ 7Width of trench-.--��--- - f ?Len!Length of each line----- ---- f Number of lines----------! g �-- Depth of filter mate ----Total length__.-/%-.-j Type of,filtermaterial._, ----- Pit: bistance to nearest well______~-=------Dietanc rom fon tion_______(/._ Distance to nearest lot line - '' _Lining material ___ Diameter--- _3-- -�----Depth..__ _Q------------------ SeepageNumber of pits - -=--- ---- S oQl: Distance fi'om ne wel -`""`"` Distance from_, oundation---------- -------Lining material------------------------ Ces p -___777 7!!Li Liquid acit gals. ❑ Size: Diameter_- - -----------Depth--------- - _ -.-- q p i Y �. Distance from nearest"well---------------------- Distance from nearest building-------------------------------- Privy: � ------- Privy: to nearest lot line_______"_____.-.- . . f 4k 1 -------------- --------------------------------------------- r Remodeling and/ repairing (describe):-------------- ------------------------ i -- - ----------------------------------------- - ------------------� --------- -------------------------`------------------•-------•------ ` %----••-----------.--------------- ------------------------------ ------------------------- tr�+.� P � � 1-hereby certify that I have prepared this application and that the,work will be done in accordance with San Joaquin County ` ""o`rdinances, State laws, an rules and retions of the SandJoaquinLocal Health District. . .Y t,„ „_.'---- a and/or Contract orl .____Own r d/o -- ---=--- Signed ----- _.; 1 :' ( 1 =---------- ---- T --- - - - -------------------------------------------------- By:------ ----=---------------`------------------------ - (Plot plan, showing size of lot, location of system in relation to wel{s, buildings, etc., can�be placed on reverse si e. + FOR DEPARTMENT USE'ONLY DATE - ------ # --- ---•-------- ----- ------------------------------ [ APPLICATION ACCEPTED BY----------------- ------ - ----------------- - - - ` DATE cif ----- REVIEWED BY---�----------------- I DATE_-- - ----- ------- ------ -------- ---- -- -- BUILDINGPERMIT ISSUED---------------------------- s - --------------------------1------•--------------------------- ------------- ---•--- , Alterations and/ort recommendations:---------i---------------- --- '----- --------------:--`----.._---•---------•-----•---• -. --•--------------------------------- ___ -------- �.ars - __"___________________ _ ____________ _-__"______________________________ ----- ___---____ _"---__-__ .--_ ------------------ Date. .. �. ---------- FINAL INSPECTION BY:---!- ---`-- ---• SAN JOAQUIN LOCAL HEALTH DISTRICT t 132 sycamore Street E 814 North "C" Street 130 South American Street 300 West Oak Street' Tracy, California Stockton, California Lodi, California ^�• Manteca, California ES-9-2M Revised 1.57 F-P.CO.