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•-''-..�;T Permit No. ---- -------------- APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) M u Date Issued' r. ,..._...—V r- . � R ' described. Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made-in compliance with County Ordinance No. 49. # f -----------•I ¢ 7 JOB ADDRESS AND LO% ATION-----T_ - =-----f------------ P^Of1e ---------- ------------- .1- ' a: ------ Owner's Name------- ----------- e --- - ------- } _ ------- ----- -------------- --•-- --•- --- Address D - - ----- - - , � � --- Pho a-- -----• ---- ----------------- ----.----- - f Other Contractor's Name------- ----------- Trailer Cour} ❑ ,Motel ❑ ❑ Installation will serve: Residence &'-"Apartment House ❑ Commercial ❑ I_ Lot size --- Number of living units: ----/_-_ Number of bedrooms _ Number of•baths ---[- _ ° Private [Depth to Water Table _A4--ft. i Water Supply: Publiclsystem C] Community system ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: ,Sand Gravel ❑ Sandy Loam ❑ Y New Construction. Yes ❑ No I� Previous Application Made: Yes ❑ No ; TYPE ONo Ne T septic INSTALLATION cesspool pe mI itted SPECIFICATIONS: previous public sewer is avai a le within 2 0 feet.] P Septic T nk: Distance from nearest well_----- ------Distance from foundation Liquid de }h__ aterie Capacity-------------------- K •.-_- ---_- --- �►` ❑ R No. of compartments------------•----------;- Size-------------------------------- q pI Distance to nearest lot line---` --•• 7.d--- Disposa Field: Distance from nearest welt- -_ _---Dastance from foundati �__j- Len th of each line---------- ------ Width of trench___a2-y...................... Number of lines----- --1---� ,r 9 F� Total length -7d ------- Type of filter material-/-- Depth of filter mater ial---_._I�------- �D+J Y p Seepage Pit: Distance to nearest well��___..___..-----mDis a1 a from founds ze nDiame---- < Distance toDnep}est lot line---------------- ❑ Number of pits------ ------Lining Distance from nearest well-----------------Distance from foundation---_--------- material----__.-----_-.---__--.-----._---s , Cesspool: ---Depth----------------�---------- -------- --,--- �-----Liquid Capacity------------------- ------•gals. ❑ Size: Diameter-------------------------- ------ Distance from nearest building-------------------- _-- Privy:' Distance from nearest well--------------------- _----- ❑ Distance to nearest lot line_- --------------------- ------------------ Remodeling and/or repairing (describe)----------------------------•---------------------•---------•---•------ ------------------- -------------------------•--;-•--- ----------- ------------------•------•------ .-- -------- her- e----b--cer+if-- that I have prepared this application and that the work will-be done in accordance with San Joaquin County !�hereby Y ordinances, Sta�s. and rules and regulations of the San Joaquin Local Health District. and/or Contractor) LQ Si ned ---------=------------------------- ------- ( 9 I BY: •-- --•-�- (Plot plan, showing size of lot, location of system in relation to wells, buildings,�e+c., can be placed on reverse side]. FOR DEPARTMENT USE ONLY DATE------------ f ------------ APPLICATION ACCEPTED BY------------------------------- ---------- DATE-------------- ---•----•----------------------------------- REVIEWEDBY----------------------------------- -------------- BUILDINGPERMIT ISSUED----------------=------ ------------------------------ - ------ -----------•------ Alterations and/or.recommen ations:-__-'------------------------------------------------------------ ---- ----------------------------- u! -----------------•-------------•------- v Dete_ ----- --------------- FI Z FINAL INSPECTION BY:------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M ; ' Revised W-2140