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` Permit No. _�l_� 5 APPLICATION FOR SANITATION PERMIT ---------- (Complete in Duplicate) Vj Date Issued lpplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with County rdinance No. 54 . JOB ADDRESS AND LOCATION---------_,, --•r--------- ___ ___._ .---- - ------------- - ,! ,.. Owner's Name--------- -------------•----------- - ----- X -----�_, _ s *C ----------- Phone Address---------------------------------------------- - -- ------------- -• - -- -----------------• -----------------------------------------------------------------/---------------------- Contractor's Name------------------- -- ---------------------------------------------------------- Phone ', �� Installation will serve: Residence Apartment H e ❑ Commercial ❑ Trailer Court ❑ Motel Lf then ❑ Number of living units: ___L Number of bedrooms _f__. Number of baths.•.- Lot size .---..__lQQ_ _ Q---------------__.___ Water Supply: Public system ❑ Community system ❑ PrivatejK Depth to Water Table.2-;5"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: Yes ❑ No$_ New Construction: Yes4 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t �y Septic rank: Distance from nearest well_ rUi-----Distance ,from foundation----/,-/--------Mater l_L__�_ r___________________ � _ _ ______ No. of campartments__._j _. Size-_ _* Liquid dep, --------------Capacity Disposal Field: Distance from nearest wel!___f�U_-_._Distance from foundation__ 1 Distance to nearest lot yin Number of lines_______/______4ining _______Length of each line____ �i Width of trench._ --------- ------- Type ----- Type as filter material -__ __Depth of filter material____. . _ ____. otal length_________ ___ _____ --- 700 __ Seepa a Pit: Distance to nearest well_ ��stance from undation -__ __ ce to nearest lot ine_ f ----- ; Number of pits----/_.._.____ material "�..__.Size: Dia ter.__ -� E pth_________________ _ _,� _..��/ • Distance from foundation___________________Linin ma ___--__-____.__--..........__._. esspool- Distance from nearest well-______________ D g f ❑ Size. Diameter--------------------------------------Depth----------------•------------- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------.-------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line----- --- --------------------------------------------------------- ------- ----------------- ------ --- ----------------------- . e Remodeling--a--n--d/o aiFing (describe) f �•- , _+ t !` Vr -- - -------- -- - ----- ------ - ------------- ------------- ---------- - -- - -- ------- Vx = -- -a"---- ------ ------------ - -- -------------------•------- ------------------------------------ -------------- -------- ----------•-----•-------------------------------------------------------------------------- I her certify that I haverepared this a pl'. ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rul regulati s the San Joaquin Local Health District. P {Signed)-------------------- _"/------- ----- --(Owner Contractor) -------------------------- - - er era r r ' - -- - BY: -----•---- W 9 (Tit P ) (Plot plian, showing size of lot, location of Sys in relation to wells, buildin s, etc., can be lace on never side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- --- ----------------- ------ -------------------------------- DATE-------- REVIEWEDBY------- ------------------------------------------------------- --------------------------------------------- ------ DATE-- BUILDING PERMIT ISSUED----------------------------- DATE--------- Alterations and/or recommendations_____________________________ __ �� s -- ----------- --- ------------;•--------------• - --- i--- — - ---_--------------------- ----------------------- ``� - ---------------------------------------- ------------------ -----%------ ---------------- ---------- rFINAL INSPECTION BY:----- s `-------------------- -----•------- Date----------------------- ----------------------------------- 4 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 ES-9-2M 10-52 Revised W-2100