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Permit No. ------- 1 :k APPLICATION FOR SANITATION PERMIT (Complete in Duplicatey Date Issued ___---1- Application is hereby ,made to the 5an'Joaquin Local HealthDistrict fo'r a permit to construct and install the work herein described. rP Ordinance - '49. ----------r--------•- -•----:- ----- This application is.made in com fiance.with County r ' JOB ADDRESS. AND LOCA ON--------�-�t , Phone------------------------------------ --------- ------------ - ,., ----- ---- --- _ Owners Name rt'y ". ---------- } Address-------------- - ------ ----- - Phone .__ . Contractor's Name_______________ ____ } Trailer Court ❑ Motel ❑ Other ❑ L7" i p artrnent House ❑ Commercial-❑ Installation will serve: Residence � .__.____. ."-------•------- Number of living units:4_,Com' �nun�i��Sy�t�m Number of bedroorris _, _ Number of baths Lot s,ze -------------------• ^'_ " Private ❑ Depth to Water Tableft•❑'Water Supply: Publicsystem ❑ ClLoam [I Clay ❑ Adobe C] Hardpan.❑ Character of soil to a depth of 3 feet: Sand El Gravel ElSandy Loam ❑ Y No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ I Previous Application Made: Yes ❑ ❑ If TYPE OF INSTALLATION AND SPECIFICATIONS: et { (No septic tank or'cesspool permitted if.public sewerisis av ila6le within 200Yf- ) , _d�ek .:: - __."__Distance frory� foundation_�'"�=-.Ma#eriaL_.�---------------------- - --- --- ' Distance from nearest well # �. _Liquid dep, Septic T nk: - _ Size--------�---------=---- - th"..__��_------- ------'-Capacity_..__.��._l1_.------ a t. ------------- No. of com artmets Distance from neares p , t wel!__-__.._____.-.`_Distance from foundation-------------�____:.D-sstance to nearest lot ine------__._____._ Disposal Field: Len th"of,each,line---------------------= . -Wath oftrench________---- =. - - ❑ Number of lines---------------------------- a g ,. . - Type of filter material------------------ --Depth of`filter matenal-_._____------- ----Total length- " -;----- ,� ". stance nearest lot line -----•-- :: y _ ...�. max— \ o a Depth ------- Seepage Pit: � :Distance to nearest well _from"founds ze n Diameter__-__-I__-- -- p Number of pits--------------- -Lining, material_-------.- . Cesspool: Distance from.nearest well----.-- Depth from foundation-------------------- Liqui.d Capacity______._____-.----- -•---•9a� t ❑ Size: Diameter----- - --"-- - pnearest 6uildinq..�---- --- - -- --- Privy: Distance from nearest well " "__--Distance from -- ❑ - -- -�� Distance to nearest lot line -=--=----- - - 5 ' _ ____________ ----- ____________ ____ Remodeiing and/or repairing (describe}:____- ____ --------------------- _, --------=-----------------------------; I hereby ce �f }hat I have prepared this application and that the work will be done in accordance wi y th San Joaquin County1 Y -re ulatioapplication the San Joaquin Local Health District. ordinances, Std e I ws, and rules an g --(Owner an Contractor] OW d/o r C ntra or] -- S, --------- (Signed) - /f ig ---- - fj - f� 11" !? _. (Title)-a tR` erse side]. > 13y. showin size of lot, location f s stem ,n relation"to wells, b mgs, etc., can be placed on (Plot .plan, g Y • FOR DEPARTMEN USE ONLY i ------------ =-------------------------- DATE APPLICATION ACCEPTED BY-- -- --- -------- REVIEWED BY------------'------------- --- ----- - E. BUILDING PERMIT ISSUED-------- --•----------•- - ----------- ------ ------•---------=- -------=------------ / dations-------------------------------------------------------------------:-----------•--- -------- Alterations and/or recommendations , ___ _-_:--------------------------- ------ -------------" '..� - Date_ - --------------- FINAL-WSPECTION•kB :-:- -- -- - ----------- ----- --- -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street 132 Sycamore California Tracy, California 130 South American Street Stockton, California Lodi, California ES--4-2M Revises 1.57 F.P,CO_