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Permit No._. ."_�_.�.`_�a_.-•"-- -APPI.9CATION FOR SANITATION PERMIT . _ (Comple'tkin Du licate '"` P � Date Issued--------- ---------------- AS/ ' l Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. S4_ AA JOB ADDRESS AND LQCATI __.-- - ------- ' --- ? O ---------------- --------------------------------------------- Phone------------------------------------ Owner's Name-------••------4•----------- - --- --- ------------- --- -------•=--------------------------------------------------------------------"-- Address------------------------ - 039 Contractor's Name----- / --------------- ------ Installation will serve: !R'esiden�ce,� ,Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ �- `v x Number of living unit's;+�f_!; u umber of bedrooms Number of baths "" -- Lot size --------------------------- Number ____________ _ Water Supply: Public system l�Community system ❑ Private ❑ Depth to Water Table ________ ft. Clay E] Adobe Hardpan Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam F1 Clay Loam [I ❑ Previous Application Made: Yes [IN'o `ew Constru n: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ N (No septic tank or cesspool pertted if public sewer'i411111vailable within 200 feet.) ` Lt/D < ---------.Material- --- --------------- Septic - ---------- W Septic Tank: Distance from nearest well _--Distance f om foundation-1-0-- Capacity ' No. of compartments_____.---- Size__9-X -- r----- Liquid dr pth ---------- - --- Dis osal Field: Distance from nearest well ..y ^-?Distance from foundationj_�Q. ----------Dis#ante to nearest lot line__2 ------------ p Len th of each line-40--- ---Width of trench_ ___�- y_---------- Number of lines----------- -------------- g /" - -- i� ---------Total length Type oz filter materiai__S_�T-I^dS---Depth of filter matenaL___. -___. g Seepage Pit: � Distance to neares#,well____--.____-_-_____-Distance from foundation____ .Distance to nearest lot line----------------- Lining material------------------- ---Size: Diameter----------------- ---Depth--------------------------------- ❑ Number of pits-�`----------- Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material_______-________-________-- "als. El ---De th--------------------------------- - ----------------Liquid Capacity- ---------------------•---g ' Size: Diameter- ------- ------ -------- ----- p Distance from nearest building------------------- ------- Privy: Distance from nearest well------------------- " -------_ Distance to nearestl lot ine__-__-----------------.-------- ----------------------------------------------------- Remodeling and/or repairing (describe):--------------•---------------------- ------------------- ----------•----------- •------- ---------- ---------------"------------ --------------------------- ------------------------------------------------- r- ----------- ----------------------------- r_ ' ------------- --•------"-----------------------------••---- ------------- ';rt ` 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. r ' -------------------------------- (Owner and/or Contractor( (Signed)---------------C �� - Title------------------------------------------------------------ --- Y (Plat plan, showin size of lot, location of system m relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY ------ -- --- ---- ------- ---� � �-- -----------•----------- DATE---- APPLICATION ACCEPTED BY DATE-------------------------------------------------- -------- REVIEWEDBY-------------------------------- --------- --- - BUILDINGPERMIT ISSUED-------------- -------- --------------------------------------------------------- ------------------------ • --T--------•------------- h/ C__ -�`�'---- Alterations and/or recommendations: ..---------•--- ---------------- --- 1 --- , --------------- ------------------------------------------------------ --------------- Date-----------4 --- ------------�.------------------------------------ ------------------------ ---- -�- - ------ -------- •- ----------------------- FINAL INSPECTION BY:------------ """""""" SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Strew Tracy, California Lodi, California' Manteca, California Stockton, California , E5-4-2M 0-52 Revised W-2100 -