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S IPermit No. . APPLICATION FOR SANITATION PERMIT 1�3 (Complete in Duplicate) pa#e Issued _____ -1' - 3 District fora ermit to construct and install the work herein described. Application is hereby made to the nce w#h CountySan Joaquin aOrdinance tNo. 544. p This application is made in complia -----------------------------•---- -------------- ---- --------- JOB ADDRESS AND CATIO ..--- .7V.- , 1 Owners Name----------- ----- --------- --------------------------- -- Phone_- =_ -1---�Z- ----• ( -1-- ----------------------•--------•----- ------ Ph --- Addressd Contractor's Name------------- ---------- -- - -- - ------------ Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will server Residence 2Aartment House ❑ ❑ Number of living units: __�-- Number of bedrooms -A-- Number of baths - __ lot size ________________ Depth to Water Table Vo- ft. I Water Supply: Public system Community system ❑ Private ❑ De p Character of soil to a depth of 3 feet:.:,l Sand ❑ Gravel ❑ Sandy loam Clay Loam E] Clay [I Adobe Hardpan F1Previous Application Made: Yes ❑ No UF- New Construction: Yes o 171� TYPE OF'INSTALLATION AND SPECIFICATIONS: r {No sap#ic tank or cesspool permitted if public sewer is available within 200 feet.] I /� r+ t ---- yet� "ter 4 Septic Tank: Distance from nearesr well_� Q-----Distance�ffromundation_---- -- -_ Mat r�a� 4 Siz CapautY � �� No. of compartmenfis--------- --------- --- 3 -_ , __Liquid dep:th-------------------- - i / �-- 1 / Disposal ielcl: Distance from nearest well-/-16 Distance from foundation--_-- -�- --___---.Distance to nearest lot line--------------- Number of lines-_: ____-- I Length of each line-------CA-d- _-- --- Width of trench----- ---------- ?r _ Total length---------- ----------------------- --Depth of filter material_______ __ ____�_--- Type of filter materia4-./�_-__ � Q I -_-_-_ ___.Distanc�e/ to nearest lot line See it: Distance to nearest well----14Q---------Distan �om foundation_ -��.-_ re a Number of pits----__-J--___---_-Lining material�- _�---Size: Diamefier--___3 ---- ass oal: Distance from nearest well---___.__..-.-__Distance from foundation--------------------Lining material------------------------------------- Cesspool: - -_..--------_-_-----------.------ C p Liquid Capacity --------------------------gals. ❑ Size: Diameter---------------- --------------------Depth------------------------------------------------ q p tY 1 ' Distance from nearest well-------------------------------- Distance from nearest building----------------------------------------- Privy: ------- ❑ Dis+ance to nearest lot ine_,.-__.___-------------------- - ------- - --------------------- ( r _-----_•---------•------------------••-------__-•----.---.---------------.-_-------------------_.----••_---.--"-- � Remodeling and/or repairing (describe)__________________--- ------------------- =€ ----- I hereby certify that I have re_ - ------ ------------------------ p pared this application and that the work will be done in accordance with San Joaquin County{... y .. ordinances, State la and rules and regulations of +he San Joaquin Local Health District. Si ned ----------- ----------------------------- ---. and/or Contractor) By:--------------- - -- - -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY ----- - - --------------------------------- DATE -7- --��-7 --------------- APPLICATION ACCEPTED DATE REVIEWEDBY-------------- ---------------------- --------------------- - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------------------------------------------- DATE.-------- --------------------------------------------------- Alterations and/or recommendations:----------------------------------------------- ----- - -- --------------------- ----•------------------------ -------------------------------------------- -- --- -- ---------------------------- � 3 Date-_ -- - -- - FINAL INSPECTION BY:------------------------------------- t -- -----------t I ' SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y ES-4-2M IO-52 Revised W-2100