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, ; ,APPLICATION FOR SANITATION PERMIT Permit No. .. ... .. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i tall thwork erein described This application is made in complianNc�ith County Ordi ante No. 544. fA 't+Vs n/ JOB ADDRESS.A , LOCATIO - t`✓ ! _----------- Owner's Name ------- v--- ------------ ------------------4- - Phone.-. 7-'z7Z _ _ _ Address -�- , -- ------------- -----'--�"- I `�' ---- -- --- Contractor's Name---- - --•- - ,� � --•----•---------------------- Phone--------------------------- Installation will serve: Residenct Apartment House ❑ Commercial ❑ Trailer CourtMotel E] ther ❑s ! Number of living units: _../___ Number of bedrooms --&. Number of baths ___I___ Lot size _p_ __ ________ ---W 7z.__(_'_ -----� Water Supply: Public system ❑ Community system ❑ Private M-<Depth t ater Table -------- ft. , Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam FT Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No•❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [ A i [No septic tank or•cesspool permitted if ubl•c sews is available within 200 fee } Septic T nk: Distance from nearest well-,_'_'____Distance from} fou cation f-i�_____________Mater I f_ 1__ ----------- -------- __________ ,,,,,No-of,compartments-----------X/-_t---,.__Size---�-�---��--.___Li uid e th---,------�--------_-.Ca stir q Fl P. P Y- t� pispasa,-Field: Distance from nearest well 0 ,-stance from foundation/ll____ Distance`to nearest 1o�fi Ii A�-------- F +� Number of lines___________ _�-u,�-_____.____ Length of each line----------K_Q_ Width of trench------- 'r Type of filter mater,- _ _ . ;1 -I3epfh of filter matenal_____/_ _________.Total length___-__-_- � ".__._L_J Seepage Pit: Distance,to nearest we' ll ___________________Distance from foundation---------------------Distance nearest lot line__._-____ l9 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------- --_-1-,Depth_-------------------:----------_ Cesspool: Distance from nearest well-----------------Distance from foundation---------------- Lining rn'aferial--------------------------------------- 0 Size. Diameter--------------------------------------Depth--------------------------------------------- ------Liquid Capacity--- ------------------------gals. Priv Distance from nearest well------------------------------------------------- from nearest.building------------------------------------------ Distance ----------- -_--Distance to nearest lot-€ine------------------------------------`----------------------------- Re ogling and/or repair,- [ scribe)_________________ 'p ---------•--------------------•------------------------- -------- ----------------------- - ---- % �h,�I C I hereby ce rKf have prepared this applica+ion and ti�at the work will be done in accordance wi OanJoaquin County ordinances, Sta laws, and rul and'regula+ions of the San Joaquin Local Health District. (Signed)----- ---------------(Owner and/or Contractor) By:----------------------------------------------------------------------------------=------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings,'e+c., can be placed on reverse side). t-, ,,;,,�NFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---•--••-_- DATE__ REVIEWED BY- ;- °` = --` :DATE-- - ---- ---------------------------- BUILDING PERMIT ISSUED___-_-"----- __�`�____`____-______``'__ _.-__ .1 _ _ _ _ --------- _---------------------------------------- Alterations and/or,,t`ecommenda+ions: -- r `' r ' = A E =- L `� " ' k 1P v- - ;trt --------------- ------------------------ --------------- - - FINAL fNSPECTION BY:---_h-- -- ------'` Date---- ------------------- --- --- L-----J------------------- AN 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 ES-4-2M . Revised 1.57 F.P,CO. _