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APPLICATION F . I � 7 � OR SANITATION PERMIT Permit No. __�-----__--------• � (Complete in Duplicate) ' Date Issued __--- Application is hereby made to the San Joaquin Local Hcalth District for a permit to construct and install the work herein described. { This application is made in compliance with County Ordinance No. 549. x JOB ADDRESS ANbLOCATION .- rye`,_---____ 1! ----------- -------t,-- - - -- - /-�--- I Owner's Name_______ =_----- -----y--- --------- ----- _ ----------- Address-------------------- - � h -- _Contractor's Name-------------- .e k t' --- ---------- l'1- Installation will serve:LResidenceo -Apar•trnent•HouseY❑ Comme�ciai sem:�Tr�eile`r_Court❑ Mo}.ef the Number of living units: ___/___ Number of bedrooms _-- Number of baths _ Lot size -------------------- Water Supply: Public system ❑ Community system ❑ !'Private Depth to Water Table !�_K ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ { Previous Application Made: Yes ❑ No ® New Construction: Yes �04 No ❑ 5t_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y , p _ Septic Not of compartments well }ante from foundadjl�ri__-/ - _Material _ p y� Liquid d�pth-------------- 0--cs IS Disposal Field: l7istance from nearest welJf _T /40 /JJ tante from foundation_ ___ _ __Distance to nearest lo} line_______________ ' Deof each line---____-- ___ -___---Width of trench--- �-----f------------ Type + u of filter materialz__--- -�_ Length th of filter material-------zI---��__.-_Total length_________�D___�_�___ __________ Seepage Pit: Distance to nearest well----------------------Distancefrom foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material---------------------Size: Diameter-----------------------Depth--------------------- # Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material____________________ -------------- Size: Diameter------ ----- Depth -----------------------------------------------Liquid Capacity----------------------_---gals. Priv ' ' Distance ftomTnearest well ---- -------D stance'c`e f-om neares `building~ ---- -- g Distance to nearest lot line---------_______________________ Remodeling and/or repairing (describe)_----__------------------------.___ -------•--------------•----------------------------- ordinances, State laws,,and rul_s and regulations li the San'Joaquin------t th --or will e - -------cor --^-San~ q L unt I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'Joaquin Local Health District. t� y7 (Signe - ------------------ ------ ---------------- ---------------------------------•------------------------------ ------(Owner and/or Contractor BY: - -- - - ------- ---- -- (Title) = .". ... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --- - ---------------------- =------- DATE REVIEWED BY - ----- -- -- - --------. DATE_-----------------BUILDING - -- - ---------------- •----------- ---- BUILDING PERMIT ISSUED---------------------- -- --------------------------- ----------. DATE-----=---------------------- ' Alterations and/or recomm�ndatians:_�____________________ !; --------------------------------- -�� -- -------------------------- - ______ ____ _______'L_-__- _________________________________ . _ FINAL4a 0--ENSPECTION :-__-.•_::_ ---- ------------------------ - - Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norte/"C" Street Stockfon, California Lodi, California Manteca, California Tracy, California f ES--9-2M 8-51 Revised W-2100