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1 - APPLICATION FOR SANITATION PERMIT Permit No: .`____ _________44 __ (Complete in Duplicate) - Date Issued ��plica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'Tapplication is made in-compliance with County Ordinance Nip. / ` JOS ADDRESS AN CATION-------- _ - ------------------ ------ --- t Phone-- Owne ------ ; -- k Contractors Name---------___-_ � --------•--- Phone---- -_-C.n ! Installation will serve: Residence Apartment Douse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ____ Number of bedroom-. Number of baths ./___ Lot size -_�� ____� - ----------------------- Number of living units: _ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table f" ^ 'E Character of soil to a depth of 3 feet: Sand [-] Gravel E] 5andy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ r Previous Application'Made: Yes ❑ Na ' New Construction: Yesly No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public..sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------- Distance from foundation_________________'.Material-------------------------------------------------- No. of compartments-------------- ---------Size-------------------------------Liquid depth_-------------- --------,Capacity------------------------ Di p sal Fie : Distance from nearest well--_------------- Distance from foundation__________________--Distance to nearest lot line________.________ 'Number,of lines------ ------------------------ Length of each line-----------------------------Width of french..--------------------------------- 11 � ❑ Type of filter material--------- of filter material____:__________-----F_Total length______________________________-____ ___-. ` ,� '• // / Seepage Pif: Disfance to nearest well_ ___ Distance from foudafion_ Q_.�___.Di ante to neareetl l--_ --- ,7� Number of pits----- materia : __Size: /iaeter-_,�________________.Depth_-((�_��-------/1171 - ------ r Cesspool: Distance from nearest well------------------Distance from foundation_--_.--------------Lining material------_-._--__-__-_________,,,w_. ❑ Size: Diameter--------t-----------------------------Depth--------------------------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_.____----------------------------------------Distance from nearest building_.________________-;__-.-______-__-_-.-. _.� .. - _. . ------------------------------- Distance❑ -- ------------- ---- ----- to nearest lot line ------------ - ------------------------ ---..,,,,:--------------------5------- Remodeling and�,crr airing (describe):__-__� - � f � }` = L.r � � - 1 ---------------------- --------------- --------------------- -•—-'__ .� ._ ----- ,. - "_ - ----------------------------------------------------------------- �-- ` ----------------------------------- ------------------------------------ 0�"I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules a�euions of the San Joaquin Local Health District. Si ned ----------------------------------- ----- (Owner and/ r ContracfoJr 9 BY� �... ------------------------ ---------- ------ (Title) rr ' `�I r .___..�µ_s__. ___1________ _ _ ___ _ (Plot plan, showing si a of lot, location of system in relation to wells, buildings, etc., can be pl on reverse el. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- --------------- ------------- ------------------------ PATE--------------- REVIEWED BY------ - , -----------------------• 1DATE----------------•--------- ------------- --------- - ---- BUILDINGPERMIT ISSUED-------------- •------------------------------------------------------------------------- ---------- DATE------------------------------------------------------------- iAlteratons and/or recommendations-------------------------------------------------------------------------------------- i f -----••-------------------------------------------•------------- -------------•-•---------- -•----------------- ------------------------------ ------------------------------------------------- 6 - _ - -•---------------- ---------•-•--- ----------------------- ------------- ----------------- ------------------------------------------------------- r � F --, l D Date---------�------------------- FINALINSPECTION BY: VSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ' ES-4-2M ; Revised W-2100