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.3-'�--g f 1" � APPLICATION FOR SANITATION PERMIT Permit No. (Complete (Complete in Duplicate) r� "--- � Date Issued _-____ �---•--- � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County rd' anc�lo. . = 'Q------- ----------- JOB ADDRESS AND LOCATION_.__:. - ---- ----------- - - Phone--- r C.c � -------------- �n Owners,Name_________________ Address--------•----------------------------------------•---------- ----------- --- Phone----------------------------------- Contractor's Name---- ----------------r----------------------------------------------------- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otherg] r Number of baths ----/- Lot size -----'~"� t---''-b Number of living units: --I-_- Number of bedrooms Water Supply: Public system Co mmunity.,.system El Private ❑ Depth to Water Table -------- ft. I Cla Loam Cla Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ y ❑ Previous Applicatibn Made: Yes [I No ( Vew Construction: Yes *10_❑ 5, TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) AA// Septic Tank: Distance from nearest well-4-1-74 from found�tion___ � :.Mater l-_---_ 1C_!_f-_?___S_.Liquid de th__--____-- Capacity.--- No. --- d• �". ----Size q of compartments_________________ - , Distance from foundation.----_ - iJis}ante to nearest lot line f c F_--- Disposal Field: Distance from near est we,l 0�_ ...e_Distance � - 1 Q Width of trench--------- `�'---------------- Number of lines_:__._____ Length of each line-------- r Type or filter material�s'T- Depth of filter material----_I-��__-- __---Total length---._-___-- ©-----------:--------- r I � __________Distance from foundation________________.__.Distance to nearest lot line----------------- Seepage Pi}: Distance to nearest well____________ ❑ Number.of pits -------Lining material------------- Size: Diameter Deptn- 1 G Cesspool: Distance from nearest well_______________ Distance from foundation- materia-----------------.---- ---"--- als. Depth -------Liquid Capacity--------------------------g ❑ Si7a: Diameter------------------------------ P hp Distance from nearest Welk______ _____________ ______ Distance from nearest building____________._-__.__________._..-__.__. V s Privy: ------- ------ ----------- 1 ❑ Distance to nearest lot line-------------------------------------------------- k Remodeling and/or repairing (describe)------------------------ ----------------------------------------------------•------------------: 1 ------------------------------------------------- --------------------•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County - ------------------ ordinances, State laws, and rules and regulations of the San Joaquin Local'Health District. --__(Owner and/or Contractor) (Signed) --------- ------------------------------------------------------ (Title)-------------------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -------- ------ = DATE-------------------•-----DATE---- -- --�---- - ---��-------- APPLICATION ACCEPTED BY------ -------------------------- ---- - REVIEWED BY------------------------- ----- ` ----------------I----------------------------- BUILDING PERMIT ISSUED------------------y----------------------------------------•-------------- DATE --6 - Alterations and/or recommendati ns:.r._ ____- . { n_ . ;� - ----------- ----- r '` - - ----------------------------------- - - --- --------- --------------------- . Date--------------------- - --.f---�•--------- FINAL INSPECTION BY:----- r''.---------- -��' SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E5-9-2M 10-52 Revised W-2104 : -