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i APPLICATION FOR SANITATION PERMIT Permit "`� TJ Na -A.-N,`-----•-- II�N (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District fora permit to c Date Issued .__ a �V This application is made in compliant ifh ourrky Ordinance No. 549. p construct and install the work herein described. J08 ADDRESS D L1bCATl N_�' �_ ---- - -�aq �� Owner's Na e I P ---- ---------- - � ------------------------ Address_._.__-�_''T_- �" Phone_ --------------------- -------------------- ontractor's Name_ � -'"----'---'---•---- -- - ----------- Installation will serve: Residence Apartment House ❑ Commercial Phone___.-•-_-___•--- • - -------------- Number of living units: _ ❑ Trailer Court- ❑I ofel ❑ Other ❑ Number of bedrooms __, Numvate V-Depth baths --l----- Lot size _L� ��nn Water Supply: Public system Y ❑ Communit ' s stemCharacter of soil to a depth of 3 feet: Sand [] Y Grave❑I ❑PrlSand Loamto Water Table ---- ft. ft- Previous Application Made: Yes Y ❑ Clay Loam ❑ Clay ❑, Adobe l/ Hardpan ❑ ❑ No W New Construction: Yes eNo E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publil sewer is available within 200 feet.) Septic Tank: Distance from nearest well,r� J `_eistance from unda ' No. of compartments_.-=----__ � Mat ripl_---- ----- f Dis os I Size__- . 1C- � )( iquid dept------_ -------------------- p� Field Distance from nearest weir---_ Capacity_ --- istance from foundation_-_. ` ' Number of lines___-_'-__�-_ _ lS� ------Distance to nearest lot lin - - ------ _Length of each line__ _ --,f_-Width of french. Type of filter materi7 ,o � -g epth of filter material__ f-------� Seepage Pit: Distance to nearest weif__---_____--__ ------ Total length----------� --____Distance from foundafion_-__ ' ❑ Number of pifs__-___---------------Lin' Distance to nearest lot line_________--.____- ,� material______________________Size: Diamef Dept' Cesspo {:-A Distance from neares ell__ Zb p ---------- --- ------- Ct ------- from found�tio,(& g Size: Diameter--__._._ � --- Linin material•_-_-- ------ -- r Depth-------------- �--- -� - ----- ----- Priv ----- ------Liquid Capacity- - - Y Distance from nearest well ------- gal ------------------------Distance from nearest:building._ ❑ Distance to nearest loft line --.---___-_--__--_- ------------------ ----------------------------------------------- Re�m deG and/or re. irin (des be ` � ---• ----- - ----------------- ------------------------------------------------------------------ -- <_ ---------------------------------------- -- *. -----•- ---•--------- -- ------ -------------------------------------------•-------•-------•----•---------------------------------------------------------------------•--------- •-- -------------------------------------------------------------- .: ! hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin Ca-- ordinances, State laws, and rules and regulations of the San Joaquin Local Health Qis+Tic+• Y (Signed)---- __ f ----------------•----------------------------------------------- By------------------------------------------•----- - (Owner and/or Contractor) -----------•-------•---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can(bJel placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWED BY------------ ---_ ---- DATE__^ r --------------------------------------------- ---------------------------- --- ---- --- BUILDING PERMIT ISSUED__ DATE___ Alter tions bd/of recon a+ions: -- TE---- --- _ -- ---------------------p .wr^ -------------------- DA . 414 j - ON + . ----------- 4 - - --- --------------------- ------ - -- g4�1 _ n - --------------------------------- ------ -=-- - --- FINAL }. INSPECTION BY:................ I / ------ --- +0 Date- `SJ -�--. 130 South American $trSAN JOAQUIN LOCAL HEALTH DISTRICT eat 360 Wast Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California ES-4-2M 10.52 Revised W-2100 Manteca, California Tracy, California