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APPLICATION FOR SANITATION PERMIT (Completein Duplicate) • [l Application is hereby made to the San Joaquin Local'Health Di' This for a permit to constr Date Issued This application•is made in compliance with County Ordinance o. Sq� uct and�ins}afl the�work h@rein described, JOB ADDRESS AN LOCATION - L, ' Own c •-/r�-� ---- - _ Owner's Name_ _ w _____ •• Address............ -• -------------------------------------------------- - - I = =------ ------ ------- Ph one Contractor's Name_ ----• i ----- --- , . ! . -----------------------=--------- -- ------ -----------------------Instalfation will serve: Residence ------- ,�,�� - ----- --- --- ------- ---- --------------- �--- ---- -•---- Phone hpartment House +] Commercial Number of living units: _ _ Number of bedrooms _ ❑ Trailer Court ❑ Motel ❑ Other Water'Su 1 ;2-- Number of baths _ __--_ Pp y Public system �Community system Lot size ,� -A . Character of soil to a depth of 3 feet: Sand ❑ Private f7! - .----..___ . ❑ Depth to Water Table _-_. � � ❑ Gravelft Previous Application Made: Yes ❑ No Sandy Loam ❑ Clay Loam ' ❑ Clay.❑ globe 9]_+lardpan 0 �� New Construction: Yes P-No ❑ ..FHA/VA: Yes [moo TYPI: OF INSTALLATION AND SPECIFICATIONS: ❑ (No septic tank or`cesspool permitted if public sewer is available within 2- feet, Septic Tank: Distance from nearest well-�� " m Distant from foundation---- � i No. of compartments-.._ �._. _ - _ ____...Material____._�:rt� ------Size_. ,)� d depth ,,4`_� -- --- - Disposal Field: Distance from nearest well_/h*L_4' _ '� Liquid �Distancerfrom foundation___-1� - ----------- --- ---Capacity__ X11_ Number of lines-_ ---____.Distance to nearest lot line_=L— - - � --- - Length of each line------ _- _ Type of filter material___ ' ---Width of trench-•- ...__Depth of filter material___--_� f` �'�� y See a e Pit: GP-_------Totaf length -•---- _� p g Distance to nearest weft__ _ - - `� g ��_�_� - - _'Dis}ante f om f ndation___-- ` Number of pits_-------/�----------Lining material--- �` Dgta��e to nearest lot fin �0 Cesspool: g ___-Size: Diameter p Distance from nearest well----------------Distance from foundation_____------------- .Lin materriiapth- ---- — ❑ Size: Diameter------ ---- ----- -- ---------------- ------------- - ------ • Privy❑: Distance to nearearest well - Depth- ------------------- - -------- --- Distance r _ Liquid Capacity_;---__<__.__ a . v - A --------- Distance from nearest building t lot line--------__-_ g Remodeling and/or repairing (describe):------- J � -------------------- ------------- ----- ` . -------------------------- ------------ --- ----- - ------ -------------------- ----------------------------- ------------------------------- ------- -------- ---------------------- --------------------------- -------- ------------------------------------------•-------------------- = I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, and rul and regulation of the San Joaquin Local Health District. (Signed) County ---------------------------------------------------_ (Plot plan, showing size of lot, locatio of s stem in relation to Contras J e (Title) y ells, buildings, etc., can be placed on reverse ✓ -- or side). 3 I= R DEPARTMENT USE ONLY �. APPLICATION ACCEPTED BY : _ ;; REVIEWED BY----------------------------------- - - ---=---- ----- ----------------------------------------------------------- ATE_-- - ------------- BUILDING PERMIT ISSU ----------------------------- ----------•------------• --------- Alterations and �recommen ations:_-__:_._,-_--__-- w DATE- --------------------------------------------�---------- --- - -----•-- ------------ -- I -- ------------- -----•- --------------- ----------------------------- F1NAL INSPECTION BY:-----,---- . . - Date----- . SAN JOAQUIN LO[3A HEALTH DISTRICT 130 South American Street ` 300 West Oak Street StocicRon, California 132 Sycamore Street Lodi, California Man+eea, California 814 North "C" Street r � - - 1 Tracy, California �ES—••4-2M • Revises 1.57 F.P.CO.