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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) . Applica4ion is hereby 'made to the-San Joaquin Local H-eaA 'strict for a Di Date Issued --- permit to construct and install the w This application is made in compliance with County Ordinance No. 54ork herein described. 1?. JOB ADDRESS AND LOCATION---7-�' 06 --------------------- ------------ -e Owner s Name-_-__ �_, --------41� Address..---_ -------------------------- Phone .2..-Ll...S.��----- - -__ -- ------------------------- ------------I------- 'Contractor's Name__-__-. --- ------ - td - ------• ------------------------------ ----- --------------------------- C-- -- - ----------- --- - Installation will serve: Residence - -------- -------- og( J--------------------- Phon parfmenf House ------ CercaEr: Trailer Cour} E] Motel 0 Other E] Number of living units:'-/---- Nu-mber of bedrooms --- Number of baths -- Lot size __/0_0------ -------------------------- Water Supply. Public system 6--cl-0-mmunity system El Private E] Depth to Wafer Table ?J--ff. Character of soil to a depth of 3 feet: -Sand El Gravel Sandy Loam Clay Loam E] Clay Ej Ado-be Previous Application6--i'l-a-rdpan El M:ade: Yes 1!�—No ❑ New Construction. Yes El TYPE OF INSTALLATION AND SPEC' (No septic tank SPECIFICATIONS: Or cesspool permitted if public sewer is available within 200 feet.)I--- rAP Septic Tank: Distance from nearest weI1rV%rk-_K___Disfan_ce from foundation--/O- ---Material --------------------- E4— No. Of compartments---__ 2---------- ----S;ze.,5�_X-402t----- Disposal Field- Distance from nearest well_!�)�__ 6Pof --------------------Capacity__/O_A_!?�------ Number o{ lines---"_-___-_ ----- ---.Distance from foundat;on---,/-q--,----.Disfance to nearest lot line---,j- ------- ----r--------- Length of each lineJ___�� -----------------Width of french. Ty�e of filter maferial__/11!1�---/?/t--Depfh of filter material.---"-.rial,-----/-,?--"'---Total length---., -------------------- Seepage Pit: Distance to nearest welj_e7o_�-----Distance from found.ation---.P--- ---- ------------------------ Number of pits,----:-I-------------Linin material-J-2- _�?_-'r._Disfance to nearest lot line__,_-_-- - 9 L��' - I --- Cesspool; _.Size: Diameter- -2-3.7 ❑ D'isfance from nearest well-----------------Distance from foundation--------------------Lining material-___-__Diameter--------------------------- ----------Depth-------------------------I ----- ------------------------ A Privy: Distance from nearest well -------------------- -Liquid Capacity----------------------------gals. r ❑ Distance to nearest lot line"-___.___-____-__-----=-------------------------------Distance from nep rest building------------------------------- ----------------------------------------------------I---------------------------------------------------------------------- ........... Remodeling and/or repairing (describe): -------------------I--------------------- ---------------------------I-----------t------------------------------------------------*---------------------*---------------*------------------------------------------------------- -------------------------------- ----------------- -I----------------------*------------*---------*----------------------------*------------- -----------------------------------------------------------*-------------------*--------- ----------------------------------------------------------------------------------------------- S, State laws,.. a f the work will be done in accordance with San Joaquin County- I hereby certify-that I have pre�Wreil this application'-and that------------------ ------------------------------------------------------------------------------------ - ordinance, and rules' regulations of the San Joaquin Local Health District. (Signed)-------- By:------- ------------- ...... ntractor) - -- --- -- ------ ----------------------------------------- e)... - -------------------------------- (Plot p.Ian, showing size of lot, I.ocafion of system in relation to wells, buildings, etc., can(Titlbe placed on- reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- -------------- --------------------I---------- REVIEWED BY DATE --------------------------------------------------------------------- -------- DATE-----BUILDING PERMIT ISSUED ------- Alterations and/or recommendations: ----------------------------------- ------ DATE------------------------------------------------------------- -------------------------------------------------- -------------------M- --------------------------------------------------- ----------------- ------------------------- ----------------------- --------- ------------------------------------------------------*------*--------------------*----------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- -- -------------- ---------:---------------------------------I------------------ -----------------------1---------- -------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------- ---------------------------------------L--------- --------------------------------------- ------------------------------I --I-- ------------- ------------------------------------------------------------------- ----- FINAL INSPECTION BY-i,, ----------------------------- ate----------------- ......................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Sfreaf 132Sycamore Street Stockfon, California Lodi, Cal;fornia Manfeca, California 814 North "C,' Sfr"t 4 Tracy, California —.,ES —9-2M Revised W-2100