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(�{ I APPLICATION FOR SANITATION PERMIT Permit No. ___ Z'-S (Complete in Duplicate) Date Issued _______.."__._ Applica4-ion is her a to `he San Joaquin. Local Health District for a permit to construct and install the work herein described. This application is m _ in compliance with!County Ordinance No. S44. JOB ADDRESS ANP LOCATION_) - ------------ - Phone.------------------------- •-------- Owner's Name. ` ---------------- ----------- Address_':--- Phone Contractor's Name-------- _ Installation will serve: Residence ❑ Apartment House [ICommercial Trailer Cour# [3 Motel ❑ Other ❑ - size ----- - .,�----•------- Number of living units: -------- Number of bedrooms __---- Number of baths _ -- of ,�y,� Wafer Supply: Public system ❑ Community system F1 Private Depth to Water Table. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam El Clay E] Adobe Hardpan El— Previous Previous Application Made: Yes ❑ No,2�_. New Construction: Yes ,%, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a { (No septic tank or cesspool permitted if public ewer is aor vailable within 200 feet.) -----Matena _-- -- Septic Tank: Distance from nearest well " - "---.Distance from foundation__.__ - - �n .Capacity !_.::"No. of compartments--------- ....Size- - - `C_ " 4quid depth----.Ll�b-------{ p Y z - Disposal Field: Distance from nearest well.. + f_...Distance from foundation___ _ --t.-. ance.tornearest line.". f--------- " Length of each line--- ,.tom- ---� - dth ofifrench__:; ----------- of lines----------- 3-fi g a f —' _. Type of filter material ------------ --Depth of filter material'_._.-._ ...........Total length------;-,--- ="'=----------• - Seepage Pit: Distance to nearest well'.--------------------Distance from foundation---------------------Distance to nearest lot ❑ Number of pits.." ------------------Lining material----------- ---------- Size:.,Diameter Dept�n Cesspool: Distance from nearest we}{"--_,•-----------Distance from foundation_..~ -------.Lining material als. QSize: Diameter--------- ----------- -------- Depth----------------------------- ---- --------------`-Liquid Capacity----------------------------gals- 171 Privy: Distance from nearest well--------------------------------- _""_.____---._Distance from nearest building_________________--.____-----.----------. ------------ --•---------------- Distance to nearest lot line-----------------------------------"-------- ---._____.___ --------" ._ `. - 1 - - Remodeling and/or repairing (describe):---------- ;y. --------------------------------- - --------- � - e --------------------------------------------- - _ - I hereby certify that I have prepared this application and that the work will bedone in ac ordanceswith San Joaquin County t ordinances, State I and rules and regulations of the San Joaquin Local Health7isfricf. C tract ----------- (Owner'�and/or on orj v -------- (Signed) (Ti+l By:_ Y g- -- ------- placed li ' (Plot ..1111 plan, slriowing size of lot, location of system in relation to we11s, buildin s, etc., can be laced on re arse;side —4 FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY------------------- Y =r" " ------ DATE------- /-,*- . - -- ------------------------------ DATE---------�---------•-----------•-----`=- ----------- REVIEWED BY_ �---- BUILDING PERMIT ISSUED---------- -------------------------- - -------------------------------- ------ DA Alterations and/or recommendations--- ------------------------- ------------------- ----------`-------------------------------------------------- j _ - --------- °---------------- -- -- ... . __. r -* ------------ ------•-------------------".------•----------------------------------------R. --------- "':,..`"'- .- _ -------------------------- - - I ` --------------------- FINAL INSPECTION BY:-.--------------------------- --- ------- ----------- - Date------------- ----------------�- -- SAN JOAQUIN LOCAL HEALTH DISTRICT yl32 S camore Street 814 North "C" Street 13o South American Street 300 West Oak Street Lodi, California Manteta, California Tracy, California Stockton, California Ery-g.� 145446 ATWD93D4 .,.