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T1 APPLICATION FOR SANITATION 'PERMIT Permit No. 5 --!j �(Complete in Duplicate) Date Issued --------.---•-�6--�_* �ppiica4`ionis hereb made to the San Joaquin Local Health District far a permit to construct and ins#all the work herein described. Y This application is made in compliance with Counrtyy r ;Hance No. 54 ../ _ - -- --- ------------------ ADDRESS A LOCATION---_.--- - -- /,', -_ - -- - ---- -- ' ------- --- Owners Name._____. __ „ _ ------------•------•-------•----------------- --- �_ ------------ ------------------------ VPhone ---------------- ,. Contractors Name----_}-------------- / Commercial ❑ Trailer Court ❑ Motel�❑ Other/❑ /Apartment artment House ❑ installation will serve: Residence ® p }} X ' ------------------------- + r of livin; units: _ -�__ umber of bedrooms _ __ Number of baths l- Lot size ____-- --- Numbe 9 Depth to Water Table ________ ft. Community system ❑ Private ❑ Dep Water Supply: Public system - Y Y Y Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;/No Clay Loam ❑ Y ❑ New Construction: Yes ❑ Previous Application Made: Yes ❑ i No i Prev PP TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. t . 1 Septic lank:. Distance from nearest well_________________Distance from foundation___`___. ____---,Materisl_________._____. -___ _----._-----_-- f,,� _ --No. of compartments---- �- - ------ -i-- ize--------------------•---------Liquid.dap#h`----------- -- ---- --Capacity Distance from foundat'son_ ler .Distance to nearest lot 1I'l 5� Dispo I Field_ Disfiance from nearest well____ ____-_ 4 � - _ _Width of trench -"' ---- ---- -_,___Length of each line______ - Number of linesa__.,... k- p Total length. ,.r Type of filter materia{------------ --- ---- De th of filter material_--- �- -•.---- - k� D IItsDistance to nearest well______________________Distance fro m foundation_--- ------ 't to nearest lot ine.___-_________.__ Seepage Pit. ❑ Number of pits - Lining 'material Size: Diameter----•----- Depth----- -------------------------- Distance from nearest well-----------------Die#ante from foundation__-`.------------..Lining material___-__-____.___-_---.------'--------- 00 Cesspool: _ --Deth---------=-----------------------------------------Liquid Capacity---------------------------gals. - Size: Diameter---- =-------------------- ---------- ------ -------- p i ❑: s Distance from nearest building------------------------------------------- Privy: -------,F--------------------- -------- Privy: Distance from nearest well___________________ _ . ... 1 ❑ –Distance to nearest lot line____________ _____ Remodeling and/or repairing (describe):___ ----------------------- 1 1 - ---- ------- --------------• =--- ---------------•-----------------------•--- ----------•--•-------------- - a ------qui I hereby certify that I have prepared thisapplication Ili the San Joaquin Local HealtheDi ne n accordance wi+h San Joaquin County ordinance , State laws'and rules and regulations1 y s (Owner and/or Contractor / - (Signed)---- •---- ------------ _(Title]---- ( nc ,. --------- -------a---------- Ay:----------- . , . (Plot plan, showing size of lot, Ioea+ion of system in relation to wells, buildings, etc., can be placed an rev rse side). FOR DEPARTMENT USE ONLY DATE.` -------------------------- - -- APPL1CATlON ACCEPTEQ.BY_ . _._..- --- DATE__- ------------------- REVIEWED By --------------- ------------------- ----------- ----- ---------------------- ------------------- DATE---- - BUILDING PERMIT ISSUED ---------•--- ----x-------------------------- -------•------- Alterations and/or--r-e--c--o--m---m---e--n--d--a--t--i-o--n- ecommen ations_______________ --------•------ --------•-------•---- --•-------•---------------- __________________ -___- _____ _____________________________ --- ___-___.____ .,Q}�j�(, --- --- ------ ----------------- - --------------- ------- - ------------------ FIti'�lAL- INSPECTION BY:._"_-:°°�""----- --- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT $14 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street !Manteca, California Tracy, California Stockton, California Lodi, California E$-9-2M ; Revised W-2100