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APPLICATION FOR SANITATION PERMIT Permit No. 4 (Complete in Duplicate) t✓ L7 Date Issued Ap'_Plica,"ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo herein d. ; 'This application is made in compliance with County Ordinance No. 549. -------------------------- F JOB ADDRESS AND LOCATIO __f" � lzt Owner's Name ---;�----------------------------- ---------------------4- _- Phone 1� Address_ . -----------I——-•------- -- -- - --------- ----- -- --------------------- -- i �:. Ph , Contractors Name-----------yrt-t -tet-:- -- - -- one -:,_. Installation will serve: Residence ApartmenS t ousa [] Commercials� Traifer Court Da Motek ❑ `Other ❑ *r Number of living units: _-I---- Number of bedroom's j---- Number of baths .-.j_kLotlsize ._,........ ------------------------ . Water Supply: Public'system '❑ Community system'❑ Private A Depth to Water Table X . ft. ) I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe []. Hardpan ❑ ; ~Previous Application Made: Yes ❑ No `j New,Construction: Yes ❑ No i f TYPE OF INSTALLATION AND SPECIFICATIONS: tx No septic tank or.cesspool permitted.if public sewer;is available within 200 feet.) i Septic Tank: Distance from nearest well-- 'bi,tance from found tion--..f¢_-------.Material--------- -- ------------------------------- No. of compartments-___ cm' ------------Size. _X.5__X__� Liquid clep`h---_-� ________Capacity---,? Disposal Field: Distance from nearest weli__ _:_ Distance from foundation-----,tiC1,------Distance to nearest lot line..:__._.._ Number of lines-------•----- ---- -------"A Length of each line----------- ----------- of trench- �-------------------- A --------�- � 1. Type of filter material__ l _'Depth of filter material-------- length--___- Q --------__--__--_---- ! / Distance to nearest well-_-_'_��_a_______Distance fro"m_�fo�un ation._.-+1�-_____---- istan nearest lot iinp____ i f.la.i#e d-Lining material-.,l_s- fc--_)Size: _ Depth---- -/------------=------- f Cesspool: Distance, kr a� i !lumbf;r o p -from .nearest well_________________Distance from foun'patios-_-._-.-___-_�'_-_.Lining material--__-___--______-_________________-__. ❑ Size: Diameter------------ ----------------------Depth-------------------------------------------- . 'Liquid Capacity-------------------------- -gals. Privy: = Distance from neare t."well---------------------------------------------- -- stance from nearest building--------------------_--------------------- ., ❑ i - ----'- --------------------------------------------------------------- '_ •'`Distance to nearest'lot line------ --------------' k or repairing (describe): -----—--- ---- G.x� �'--� G► ' ++�' — i --------`_ -•------------------------------------------------- :, , I hereby certify that !,have prepared this application and that the work will be done in accordance with San JoaquiW County ordinances, Stele laws; and rules and regulations of the San Joaquin Local Health District. i (Signed) 4!4, ---o------ ---- ----------- ----------- ---- ------- ---------------------- ---- er armor Contractor) _ _ '` +# ~s = 'LTitle) -•---- - --------------------------------------------------- By: --------- (Plot plan, showing size of lot, location of system in relation-fo wells, buildings, etc., can be placed on reverse'side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- All ----- DATE--- - --- ---------- REVIEWED BY__-_- —__._= — __ _ _ -. r. ----* --------- ----------- -----°`_..-_..------••-.--- -_- DATE .,._ r ll BUILDINGPERMIT ISSUED------------------------------------------------ ---------------------------------:-------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------- ll -- - l �w[ - 't --`-----------------_----------------------------------------------------- -------- ------------------- ------- I 3 . 11 it --- -----:--.. --- - '-------------------•-----'--------- - - ------------------------------ ------------------------ --,----------------------•------•---------------------.--------- ---- ---•` - - -- F]NAL-INSPECTION BY- --------------------- i� Date---------------------4- -- ---—'=--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT OY 4130;5 uth American Street 300 West Oak Street 132 ISycamore Street 814 North "C" Street Stockton;California Lodi, California Manteca, California. Tracy, California E —,1 2M Revised W-2100 i