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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued MMApplica+ion is hereby made. to the San Joaquin Local Health District for a permit to nsfrucf and install the work herein described. This application is madein{compliance with County Ordin ce No. 54 JOBADDRESS AND/ TION------ ----- - ------- - ------------------------------------------------------------------- ---------------------------------- Owner's Name____----- ------- Phone ---------- Address------ fi ------- ----- -------------------------------------------- ......---------------------•---• ------.. -----------------------------....... Contractor's Name----- .............. ----------------------------------------------------------------------------------------- Phone.__.,_ 3K_7,----- --*' Installation will .serve: ResidenceX Apartment House'-s '- Ej, - Commercial I—] Trailer Court 0 Motel E] Other E] u e Number of living units: Number of bedroomsv-Z. Number of baths ./-- Lot siz; ...... ----------------- I Water Supply:— Public systeM Community system [I Private E] Depth to Water Tabl ft. Charac;erof soil to 6 depth of 3 feet. Sand El Gravel E]- Sandy Loam [] Clay Loam ❑ Clay ❑ AdobbX Hardpan 0 Previous Application Made: Yes E] NOX New Consfru6f iori: Yes)X No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epfic T k: Distance from nearest well-----------------Distance from foundation--------------___.MaferiaI__---------------------------------------------- %19 No.' of compartments--------------------------Size__---------------------------Liquid depfh---------------------------Capacity----------------------- _7 p Di" osa 'Fj -Distance fFo—m— nearest well------------------Distance from foundation------------------- Distance to nearest lot line________________ '0 Po ti Number oY lines-----------------------------------Length of each line--------_-----_----------__--.Width of french-_- ------------------------------ ype of filter,rn�iterial_-----------------------Depth of filter material-----------------------Total length-------•---•----••------------------------ T Seepage Pit: Distance to nearelsi well---------- _-.1-Diitance T fouticlation ......... Distance to nearest lot line...... Num' ber.of pits----/--------------Lining mat�ri 2� --Size: ..................Depth____--- V Cesspool, Dist6nce from nearest well---------- Dist n ' from foundation..------- -----Lining material_____________________ ❑ aterial--- -----------------El Size:,biarnete'r--------------------------------------Depth----------------------=---------------------------Liquid,Capacity------,:--------------------gals. Privy: Distance from nearest well-------------- ______Distance from nearest building-------------------------------- El Distance'to nearest lot line-------- =and/or ---- --- --- -- -- ------------------------- -------------------- Remo Iing X; - --- .. ---------------airi describe)____ --------------- ------ - ............ --- --- -------------------------------------------------- --------------------- ......... --------------- ------------ --------------- --------- ---- ------------- ...................... ......------------------------------------------------------------------------- - ----- -- ------ -------------- - --------------------------- ------ --------------------- ------------------------------------------------------------------------------------------------------------------------------ ------------I------------------ I hereby certify that I ha-v prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Sta' aws,'and 'and regulations of the-San Joaquin Local Health District. {Signed]-------- ---- -- -- ---------------/--------------------------------------------------------------------------------- ------- Owner and/or Contractor) By....................... -------------------------------------------- ----------------------------------------(Tif-I -- - --- ------------ ----------------- (Plot plan, showing sizeo I,ot7 location of system in relation to wells, -buildings, etc., can bee�-------- __* pl/6-6-don r e e - F FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED 9Y�-- --- -------- --------------- ---------- ------ ------------------ ---------------------------------------- DATE ------------- DATE —---------------------------- REVIEWED BY-------------- ------------- --- ;, ___----------- BUILDING PERMIT ISSUED............lu :_ _---:-------------------------------------------------------------------------------------- DATE----- •---------------------------------------------- Alterations and/or recommendatibris-------- --------- -----------------�m_---==_ == -°=------==------ =-------==-- ='----------------------•-•------------ ---------------- -------- --- --- --------------------------------------------------------------------......------------------------------------------- - -- -------------- - - ------- ----- -- ------------- -----------------------------------11------------------------------- ------------------------------------------------ ---------------------------k----------------------- --- ---------------- -------- ------------------------------------------I-------- -------------------------------------------------------------- '---------------------- - --------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY--- --------------------------------------- -------------- ------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California B-9-2M Revised W-2100