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`-- APPLICATION FOR SANITATION PERMIT Permit Flow. _ _ -.�__�J � (Complete in Duplicate) 29}_ j Date issued Application is hereby made to the San Joaquin Local Health DiNoc fo a permit to construct and install the work herein described. This application is made in compliance with County Ordince JOB ADDRESS AND LOCAT ON____•-3- - -- - ' --------------•--------------------------------------------------------------- ------- Owner's Name-----------"-`=-- --- --------�- --- Phone -�--/-3-�------- Address___________________ s` ------------ --- ---- ----------•------------------------------------------------•-------------------•-- -•---- - - - - -------------------------- -------•------- ---- Phone------------------------•- Contractor's Name----------------------------- -----�------------------------------- -- - -- - ----- Trailer Court Ll ❑ Other ❑ . Installation will serve: Residence 9'Apartment House El Commercial f-1 Number of living units: __�_.- Number of bedrooms _7L—Number of baths 7 -- - Lot size - ---- 1-1y -- Water Supply: Public system ❑ Community system ❑ Private R Depth to Water Table ft. Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe,,{] Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y _ - Previous Application Made: Yes ❑ No ,N, New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Ifoundation 1 ------- Septic Tank: Distance from nearest well from foundation_____ _ _______Materia_-__---- _---Ca acit - No. of compartments------�------------Size---P X_�_ -- --------Liquid depth---- ---= --- ---- p Y---- Disposa! Field: Distance from nearest well_.-- �?----.Distance from foundation-_-�a Distance. to to nearest loft line---- ____._--" nearest -- --_ _-- Len th of each line-----------�-O�-------Width of trench_------.,---------------------- Number of lines-------------; _ �� ------- g -------------------x Type of filter.material_Ih= -_112 -----Depth of filter material-------10"----- -Total length---------1----------- 4 Distance from foundation----------------___.Distance to nearest lot line----------- Seepage Pi}; Distance to nearest well- Number of pits----------------------Lining material--------------------- Size: Diameter Depth ---- ❑ Distance from nearest well-----------------Distance from foundation---------_----------Lining material__------------------------------els. Cesspool: ---Liquid Capacity --9 ❑ Size: Diameter Depth ---------------Distance from nearest building_-__-_--_-------------------------------- Privy: -----------------•-------- Distance from nearest well_ ------ -------- ------- - ------•---------•------- ------------------- 11 ❑ Distance to nearest lot line----------_------------ --------- ti � - Remodeling.and/or repairing (describe)-------------------------- • ---_-------- -__-_._-_.. _-_ _______________________ -------------------•-------- _. _ -------- ----------- ere ---------------------- -that------ have------------prep-------------------------------------------------------------------------------------------------------------------- --- _-----___-_ I hby certify I ared 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. . f -----------------(Owner and/or Contractor) ` -------------- ----------------------------------------------- -------------------------------- Title --------------------------------------------------------------- ---- [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 s DATE-------]- -------{ - _ f/ -- -- APPLICATION ACCEPTED BY----------V„ 4 DATE------------------------ ---------------------------------- REVIEWEDBY---------------------------------------------------------- ---------------------------------•-------------- ------------------------ DATE--------------------- ----------------- ---------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ------- -------- ---------- --------------------------------------------- ------------------ ------------------------- ------------ ------------------------ Alterations and/or recommendations:_------------------------- --___---__---_--__-__-___..__. ------------------- ------ --------- - ---D---a-t--e------ ate---- --- a- --'�--•------- -------- ---------- --------------- FINAL INSPECTION BY:__-.__---W--- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy,-California Stockton. California Lodi, California ES-9-2M'8_51 Revised W-2100