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APPLICATION FOR SANITATION PERMIT Permit No. d' - (Complete in Duplicate) Date Issued __T___!-]r•-- ----- in Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin i This application is made in compliance with County Ordinan rAo, 519 . i--� E '� ___!- - --•- -•- -- - — � . k- -----------------------•---------------••-----•-•--•--------------•------------------•----r--------�----•---------•--�-----•--------- -�- - JOB ADDRESS ANCATx• e one- - -- .- - Owner's Name______ ----- ------------------ Address ---------------- -------- --------- - - ! ` ------ Phone-, of _ Contractor's Name----------- ---- ' Installation will serve: Residence Apartment House F1iCommerr66l`❑ -Trailer Court [IMotel [3Oth ❑ --- Number of -_ - . - ------ Number of living units: -_}__ Number of bedrooms _-� baths --/.__ Lot size - ( De, th to Water Table• a ft_ Water Supply: Public system Community system ❑ Private ❑ u 1 ❑ y ❑ y Adobe ( Hardpan Character of soil to a depth of 3 fest: Sar+d ❑ Gravel ❑ Sandy Loam Clay Loam Cla ❑ ' ` ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALL ATI AND SPEC FICATIONS- (No septic tank or cesspool permitted if public sewer.i available within 200 feet.) t Septic Tank: , Distance from nearest well-----------------Distance from foundation_-_.__-----`__-:_:.Material_-----_--_-_---- ------------------------------ ----------------- ..__---_-_------------_---- 1 -- -----Capacity---------------------- No. of compartments--------_---------------Size--� =---------- ----------•-Liquid depth--- r �� r i f I '"�isposa Field: Distance from nearest well__--.__---__..._.Distance from foundation--------- ---------Distance to nearest lot line---__----_.___-. Number of lines-----------------------------------Length of each line------------------- lNidth of trench.---------.-------- O r Type of filter material--------- -------- --- Depth of filter material-------------------�Total length-------•---------------------------- v Distance to nearest lot line-_- __---- Seepage Pit: Distance to nearest well Distance fr m foundation _-- ----------- Depth Number of pits---._/_.-_------_ ining material- - _ --- Size: Diameter ' Cesspoo4: Distance from nearest we -----------------Distance from foundation-----..--_--------..Lining material--------------- Size: Diameter------------- --------- --- - p ` De th---------------'----------------------------------Liquid Capacity---------------------- -----gals. El ---- - Privy: Distance from nearest well--------------------------------------- ------Distance from nearest building--------- --------------- ._ ----------------------------------- ❑ Distance to nearest lot line--------------- ----- --------------------------- Remodeling and/or repairing (describe)--------- - --- ---- ---'-1�--------------------------------------------------------------------------•--------------------- -------------- --------•----------------•------•---------------•----------•----•-----•----------------•-----•----------------------------------------------------------------- ---------------------------------------•---- ------------------------------------ --------------------------------- ---------------------------------------------------------------------------------------------•-----------------------•-------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,,$t ate s, an le and regulati ns of the San Joaquin Local Health District. (Signed) - ---- -------------------------------- ------- ------------------ ------------------------- -------------(Owner and/or Contractor) By:_ (x -----` - ---------------- --------- ---- ---------------------------------------- Title) .� =---------- ---------•--------- �� . (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be ced on reverse sid FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ----- ------------- --------------------- ------ ------------ DATE - REVIEWED BY �, - DATE BUILDING PERMIT ISSUED------•---------------------- --------------------------------------------.- DATE ----------- � Alterations and/or recommendations:_-------- -------- - - ------------- 4 ---------- ----------------------------------------------------------------------------•-------------------------------•-------------------•---------•----------------------- -- } ----------------------------- ------------------------------- ------------------•-- ----------------------- Date -------------- t - -----•---- FINAL INSPECTION BY--------------- ------ ',� SAN JOAQUIN LOCAL HEALTH DISTRICT 132 $ camore Street $14 North "C" Street 130 South American Street 300 West Oak Street y Manteca, California Tracy, California Stockton, California Lodi, California } ES-9-2M 10-52 Revised W-2100