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Permit No. ..-----`-=-- APPLICATION FOR SANITATION PERMIT 0/------- ' (Complete in Duplicate) Date Issued . __.------L---- � Applica--ion is hereby made to the San Joaquin Count Health DlNoc 549r a permit to construct and install the work herein described. This application is made in compliant Y , '� -------- -�-----•--- e JOB ADDRESS D OC.�T10 .-- 1 Phone ` - ' - -- ------- --------------------------=------- - Owner's Na - -------- - -------------- ----------- - Address.____ __ - ------- Pone---------- ----------------------- Contractor's Name _----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ .�o)el ❑ Otter ❑ r ----- Lot size __~�_---- --�-��-•----------------------------- Number of living units: _1-- Number of bedrooms �i1--. Number of baths _� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Sandy Loam Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ S Y Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ ` (No septic tank or cesspool permitted ifpublic kew r is available within 200 feet.) - scan e from faun tion_ __ _ It`_ Septic ank: Distance from'nearest we __ 'f n Ca acit ! U ---- W X�V K _Liquid e th-- - P Y Nc. of compartments- ----- ize q P. , ' O_�istance from foundat'on-ii-j--!-'-'=istance to nearest lot//l�ine__, G Dispos Field: Distance from nearest wel._ry- Q--- -- - - �f.� .Width of french------ V- ----------------- Number of lines{________________�[---------- --Length of each line_"_-_._-- � TYPe of filter m�teriaL_______-------- -----=Depth of filter material_.--------------------Total length------------------------------------------ Type ---------------------- -------- -------- Q' .__.. s Seepage Pit: Distance to nearest swell______.__.__._______Distance from foundation______________ ____Distance to nearest of me____._________-_ ❑ Number of pits----------------------Lining material._----------------- Size: Diameter Depth--------- Distance from nearest well from foundation---------- Lining material-- __"__----------------"----ass. Cesspool: Li ui.d Ca acit 9 ❑ Size:-Diameter -------'------ --- ---- ----- -Depth------------------------------------------------ -------------------- ----- -- --- -- Liquid Capacity ------ -------------------Distance from nearesf building------------------------------- -----t Privy: Distance from nearest well------------ - -------------------------------._! - ------------------------- --- ---------------- ❑ Distance to nearest lot ine___.__..____-________ ___ ____ x • -----------------------------•-- q 113 Remodeling and/or repairing (describe):_---__.-_.--------- --- --------------------------------- ------ --------------------------------------------- ----------------------------------- --------------.------------------------------------------------ - - --------------------- --------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin ou`i ordinances, State laws, and pules and regulations ations of the San Joaquin Local Health District. i _ _.--_-(Owner and/or Contractor (Signed) . ,4" z==.- T:- < , (Title)_-------------------------- Ry----------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ------------ DATE_ --------- i ----------- --------------------------------------------------- - DATE_.--------------- -------"---- ---------•---"------ REVIEWED BY-------- DATE BUILDINGPERMIT ISSUED---------------------------------------------------------- - -------•----------•--------------------•------------- ------ ----------------------------------------- Altera+ions and/or recommen a+ions:___'____..___ - '----------------- -------------------------- g 6 FINAL INSPECTION BY---------- ---------`'-----_ ----- Date 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Lodi, California Manteca, California Stockton, California , Revised W-2100