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,. . APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) 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. 544. JOB ADDRESS AND LOCATfON_ : - - yam__ Owner's Name- ------ -------- ------' ------------------------------------------ Phone---------- .�.. ------------------- Address........---•-------- ._�'�__ d.. s�� . - Phone..__ .__ _ Contractor's Name--------------------------- : q -Installation will serve: Residence 54 Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: __ _._ Number of bedrooms . �_ Number of baths -_ ._ Lot size - "-I b---------------------- Water -------_.-.--_ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table _`10 ft, , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ � Previous Application Made: Yes E] No j< New Construction: Yes ❑ No ❑ /� � +eg!� = x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)x Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material.___-__-__"_._______._-__"____"_ f ❑ No. of compartments------- Size------------------------------•-Liquid depth--------------------------Capacity.— I F Disposal Field: Distance from nearest weiL ifl.Q_-..-Distance from foundation__ -------____ _Distance to nearest lot line_-_-0.7"___ Number o{ lines--------- ----...- �- ---Length of each fine . ,p--4'----------Width of french....A V_ ,*t"---_---_"---- I Type of filter material-__"-_. Depth of filter materia"I______,_.1 ''---Total length___. --------------- See `____._______ Seepage Pit: Distance to nearest well-- --*0Q*--_---Distance:from foundation_ A37_..__. Distance to nearest lot line__._3"--_.___ �T Number of pits------/-------------Lining material__ r _ ze: Diameter---_%� 0f___ ` ---------- 001: .------- oo€: Distance from nearest well................Distance from foundation--------------------Lining material----------------------------------------tp ® Size: Diameter---------------------------------- --'Depth----------------------------------------------------Liquid'Capacify--- ------------------------•gals. Privy: Distance from nearest well-------_ -----------_----------- -----------------Distance from Weare f building ----------------------------------------- ❑ Distance to nearest lot line------------------------------------------- - �- i y Remodeling and/or repairing (describe)----------------------------------------------------------- a --•-------- ----••------= -----------•------•- s --- _ _ --------------------------- -----------------------------------------------------------------------••-------------------------------------------------------------------------------------------------------------------- 1 I hereby rti y that I have pre ed this application and that the work will be done in accordance with San Joaquin County C ordinances, St t ws, an .rules a regulations of the San Joaquin Local Health District. till, (Signed)-------- LA__ ' ------- --- ------ ----- t 1103. BY: ------------------------------------ -- .. -- �+ � ontrac ori ' " - -- -(Title}----�` __ _.!� ' ----. ...... (Plot plan, showing size of lot, location of system rela+ion to wells buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r - DATE' --------------- ------------------------- -------------------------------- REVIEW ED BY -----------------=------------ ---------------------------------------------- DATE--o"s QjN ---------------------- BUILDING PERMIT IS ------- SUED ----------------------- ----- -- DATE-------- l Alterations and/or recommendations:----------------------_------------------------------------------ ---------------•---------------•------------------_---------------------------------------------------------------------"•----------------- •----------------------------- -------------------------------------------•------•--•------ ------ ---------------------------------•-----------------------•---•-------------------••------ ------------------------------------ 1 -------------------------------------------- -------------------------------------------- FINAL INSPECTION BY:---------- `--------------- -------------- Date----J.��_�. - -------- - --------------------------------- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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 10-52 Revised W-2100