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- Will APPLICATION FOR SANITATION PERMIT Permit No ------- ----- P, {Complete in Duplicate) � Date• Issued Qf /0 f S Application is hereby made to the San}Joaquin Local Health District for a permit to construct and install the work herein described". This application is made in compliance with County. Ordinance No. 54 �. _-1.: ------- --- -----..."--- _-:----------- JOB ADDRESS AND• CATION_____ �_ ""---'"`�""" :. Name___ ___ _ .�i�- -�---------- �� ----------------- ----------- Owner's Phoneme � :-- .. ate:..-� ....-�..,,..,.... . - t ---------------------------------------- -- Address ---1---------- Contractor's Name---i-------- ------------ Installation *- -F Phone _ �-�- ------"- Installation will server Residence [Apartment Hous6f ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _" Number of bedrooms __ - Number of baths _ ____ Lot size f �' - -•--- -- Water Supply: Publib system �Comrriunilty system ❑"Private'❑"'Depth to Water Table �'ft." Character of soil to a depth of 3 feeti iSand ❑ Gravel L]—Sandy Loam❑ Clay Loam' Clay ❑ Adobe Hardpan ❑ Previous Application-Made: Yes❑ No ® New Construction: Yes E]..No FHA/VA: Yes ❑ No ❑ i 4 TYPE.OF INSTALLATION AND SPECIFICATIONS: ( p. P P P hin 200 feet.) Se tic Ta k. Distance from. nearest well-Distance,from fou r - � No se tic tank`or cess ool permitted if public sewer is available wit ndatiorr___ _ Material , -.- -- P� --- - No. of compartments--.._-- -------------Size__ � �'-_ --- ---------- depth---'�' ____"_""--Capacity_.:. .. ' It i.. j_____.Distance to nearest lot line__._ Disposal Field: Distance from nearest-wO" � Distance from foundafi _ ___-_ I .r. Number of lines----:-- --'---- -------- ---t Length of.each line----- -------------------Width of trench._2A -----------------...-� Type of filter matenal _Depth of filter material____' ____-1- -,Total length_______ �__"___-____"_--___.-__"W - ; �w-' -.....Sizer D ameter nearest lot line----------------- Di --•-------_"_--- Seepage Pit:. Distance-to nearest well_xr Distance from foundation_______________ ' Distance to ❑ Number of pits------ -- Lining material ............ ----- 4-- Depth---------- Distance -- - _ [ � N Cesspool Distance from nearest well .... Distance from foundation---------------_'. Lining ma-terial__ ----------------------. ,......_.F _. ��. ... .. FL ---------- ---------------------------------------------- gals. . Size: Diameter ' ' - Depth x ._ iquid Capacity' �� _ - " _Distance from nearest buildin Privy: Distance from.nearest welV... .... g '' +" ❑ _L.. .r� s ------------ --------------------------------- Distance to nearest lot line: r ------ - lin and or re pairing) describe ________________ --------------------------------------------------------------) r Remode g P 9 { -' -------------- ,T - -- 4 {-----"----- r ...,.'-. ...i. .. •------------------•---------------------- - -----I- ------------------•-------------------------- --------------- 4i: 3- �: _ ! t • ----------�- --.. k gon and that the work will-be done in-accordance with San Joaquin County 1-hereby certify that I have prepared this applicati , ordinances, St laws, an les and re ulations�the n Joaquin Local Health District:Vi r ------- -----Vt_ ----------------- ------------ ------------------------- (Signed) --.--_ Owner and/or Contractor) -------- a. ------- ........... ---------------- ---------------- - -------------------------- ---------------------- 4 - Ri (Plot plan, showing size of lot, loaatioin f system in.relation to ells; buildings, etc., can,_be placed on reverse side). * FOKqEPjARTMkNT USE ONLY APPLICATION-ACCEPTED BY--.-" :___ -_ _ --- ----------------- DATE F �� ---------------------- ------- REVIEWED BY } DATE-------------`---------- :•-------_---------------------- BUILDINGPERMIT ISSUED---------- ------`-------------- ----------------- --------------------------------------------- DATE---------- :------- - Altera ions and/or.recommendatio ------ - ------- ----=---------- - I r --------------------- ------•----------------------------------------- ------- } .F . ------- ----------- -- ------ ------------- --------- �FINAL INSPECTION BY: _V, `---=-=------ -= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street k Manteca, California Tracy, California Stockton, California Lodi, California r9-2 K4 . Reviseci 1.57 F.P.CQ.