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S� ,� --�--- N o'� APPLICATION FOR SANITATION PERMIT Permit No. -4t (Complete in Duplicate) Date Issued �--�--0 -� Application is hereby made to the San Joaquin Local Health Dice strict for o a permit to construct and install the work herein described. This application is made in compliance with County t♦ h JOB ADDRESS AND LOCATION----___._ o __ ,�_. - Phone '_rSf� -- Owner's Name------------------------ --------------------------------------------------- Address . Address--------------------------------------- Phone ------ ------------ -------- ----- ------------ ----------- ------------------- --- --- ----------Contractor's Name----------------------- ---- Other Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence l( Apartment House ❑ t Number of living units: _ ___ Number of bedrooms Number of baths -__ Lot size -.�0y--��-� t l c _� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table •-/--'ft. Adobe Hardpan ❑ Clay Loam Clay ❑ Ad �, P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ❑ Previous Application Made: Yes ❑ NoW New Construction: Yes ❑ No ❑ 54rr +^� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ------------- ----------- --------- o � tic T �k: Distance from nearest well-----------------Distance from foundation-----------_-___-_-.Materia----- - - -- __ Capacity No. of compartments--------------------------Size-------------------------------Ligwd depth P Y N 1�J �O-'____--Distance to nearest lot line____-----� O''.__Distance from foundation______ . Di pos Fsielcl: Distance from nearest well _--__ _ Len th of each line_____ Width of trench.-_-_ca -- - --- y'`I Number of lines_____________ sp _ _ 9 r� Jw� Depth of filter material____-----_-Total length__ ------- - O 6,,J Type of filter material_----2- - P I ^� ll_ _ '-1'-----Distance from foundation--/ r__.__.___.Distance to nearest lot line-____5 Seepage Pit: Distance to nearest we ----- JK Number of pits- -- ---------------Lining materiaCe_ __-__ -----Size: Diameter.4.3!1-----------Deptn_2 Distance from nearest well_________________Distance from foundation-------------------- aerial gals. .� Cesspool: q Capacity ----------------------- ❑ Size: Diameter----------------- -- ---- --- ------Dept -------------------------------------- from nearest building_-___-__-___-------------------------- Privy: ----- - Privy: Distance from nearest well--------------------------------------------- ----------- -_ -- \ ❑ Distance to nearest lot line-------------------------------------------------------------------J --------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ---------- I her �Iaand t I have prepared this application and that the work ill be done in accordance with San Joaquin County ordinanc , Starules and r gu tions of t an Joaquin Local ealth District. .:: �°� Contractor ( 9 )---------- ------- `M�r ----------------------------- By: -- ------ Title --------- - - ----- BY:-------------------------- - - --------------- -- - ------------------------ buildings, etc., can be place on reverse side). (Plot plan, showing size of lot, location of system ' atio to ells, FOR DEPARTMENT USE ONLY --------------------------- ------------------------------- DATE-------NAPPLICATION ACCEPTED BY ------ DATE r --------- REVIEWED BY-------------------------------- ------------------ --------------------------------------------------------------- ------------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------ --------------------- ------------------------------------------- ------------------------------------------------- Alterations and/or recommendations--------------------------------------- -- ____.. ---•----------- ----- --- -- ------------------------------------ ---- ---- - - --- -- --L --- -------- -- -- ----------- ------------------------------------------ ----------------------------- - --------------------- Date--- FINAL INSPECTION BY--------------------- ="-------`I--- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT y 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California Y' FS-9-2M I0-52 Revised W-2100