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APPLICATION,oFOR SANITATION PERMIT I Permit No. a_ .-p. [Complete in Duplicafe) ' *f 5' Date issued ._-. _I-----3 �Q Appli ation is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work h r in described. ,I This application'is made in compliance wi h County �No. JOB ADDRESS A s LOCATIO __ __�__ _ ____ _ Owner's Name-- ti - --- -- - --- - -------------------------- Phone------------------------------------ -------------------------------------------------------Address----------- -= t •--- Contractor's Name___ ---- --------- --- --------- --------------------------- J------ -- Phone------- --------------------------- Installation will serve:. Residence Apartment House ❑11 Commercial E] Trailer Court ❑ Motel El Other E]Number of living units: __1____ Number of bedrooms _-_!-_-. Number of baths __�"__ Lot size _ Q _ _ _l:.f_________________________ Water Supply: Public system:El/Community system O---Private•O--Depth.to Water,.Table—:.--_,ft.-- Character of soil to a depth of 3 feet: San ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ fAdobe'�ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Loam ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well - ' '__'Distance from foundation___�"___'�'___:__.Material_____ -----------------------:_______-_.._. No. of compartments j:(-•," Y- 2 �` '' �` ° �� g ' p ----------'-'-'-------'--Size-----------------------=--------Liquid dept�i----';�--- ------------ Capacity---'=- -;;--�' --'---- t �' } 't\ Disposal Field: Distance from nearest weli__ ArtfJ_..'Distance from foundation_ ---------------_.Distance to Barest lot line__-- Number of lines------I-------------------- ----1 Length of each line---- -----'--- ;-------.Width of trench.- - --• =: fo\' �:. ofilter maierial � I---(Depth of filter material___. _-__.._-.-__._Total lenghi fPfr-,r 4fir- r .1 ----- - --------- - I ' r. Seepage Pit: Distance to nearest well--1 --_}_Distance fromk foundation__ ._. Distance to nearest lot line_ �3 Number of pits----------}-____-- _Lining terial •T-�j.__.Size: Diameter---_- -' ---- --- Depth '--------.'-- -- I Cess Distance from n est el�____.___._ Distance from oyclation-_,1-I� aterial__- - _____ ___ - -- f✓ y p 0Size: Dia mote ____..__._._"__Depth______._ _ Liquid Capacity__. _l __-0__�__g I Privy: Distance from nearest vrelL__.__ _____ __----V' __ ._____._Distance from nearest building__ __ ------------------ - _________________ Distance to nearest lot line___/_Q___i___ _ ----- -- -------------------- Re o el g and/or repair- 1 esc be}:-'-' f /= ' :_..__./771 f_-� --- ------------------------------------ -- ------------ ...,'. �Y. fir»�. 4 -- eF t ---------- --------------- ------—X---- -------------------•---------- `Y I hereby certify that I have prepared this application and that f e work will ne in'acco- dance with„San Joaquin County ordinances, Sf fe laws, and rules and regulations of the San Jo-aquin Local Health District. . Owner-and or Contractor (Signed}-•�� -�-------� •� � -----•----------------'-'---------- ------- .-------------------------•- ------------- - { � } i B ' " �� (Tale}._�`��:��_=--�,�.�---------------------- (Plot ---'---------------'(Plot plan, showing size of lot, location of system in relation to we lls,'buildings, etc.1can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- 3 ------ --------- -------------------------------------------------------------••----- ---- DATE- ----------------- - REVIEWEDBY-------------------- - ------- -------------------------------------------------------------- DATE---- -------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------- ------------------------------------- ------------------- DATE --- ---------------------- Alterationsand/or recommendations:---------- ------------------------------------------------- ------•-•---------------------------------------------------•-------------------------------- i �.. — ------------------------------------------------------------ ---------- - FINAL INSPECTION BY____ _________ ____ - ------------------------------ Date. --------- ------ 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 fi ES-4-2M 10-52 Revised W-2100