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r APPLICATION FOR SANITATION PERMIT Permit No. ..... ... (Complete in Duplicate) Date Issued -Y 1 ApplicaTion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATIO cam.-f. ?. - ' Owner's Name-------------. " jr- 7 Phone _ _ Contractor's Name-----�`--------�'- i0----••---� '-'-�----------� /__;1_1 w �--(' Phone_ s.��.��' -`�-" Installation will serve: ResidenYc�e Apartme-t House ❑ Commercial ❑ Trailer Court ❑ 'Motel 0 Other ❑ r I Number of Irving units: 1. W .be'r• of bedroom _ __ Number of baths _ Lot 4 . +� 8 Water Supply: Publicsystem Com` r�4.Ftjr system 0 Private E] Depth to Water Table ��2 ft. Character of soil to a depth 3 feet: Sand ❑. Gravel ❑ Sandy"-o m[t Clay Loam ❑ Clay ❑ Adobg.M Hardpan ❑ I k� Previous Application Made: Yes ❑ N� New Construction: Ye,§� Itlo (] TYPE OF INSTALLAT{ON AND SPECIFICATIONS- f (No septic tank`or ces�oaol permitted if public sewer is available within 200 feet.] ' _ : � .. .� Septic Yank: Distance from nearer+ weN____*_______•+'_'"{�istance from foundation-------___________. aterial_-__________.________________._..___.._._______.. J -w- No.-of%compartmeennts_-----_- �_ -_SIS Liquid,:dep`th.----•--_ ----- Capaci ty-------- ------------- Id., ------------ 1 Field: Distance from nearest wefi-------I ------ Distanco.#rom.:fol ndaiion__ Y-»_- Distance,-#o nearest'lot--line----------------- Number of-lines--------- •--- ----- --- .'. en th of each line%-------------- width of�trenCh----------------------------------- Type ------------- ------- --------- --J Type of filter materia -------------- ____` h of filter material_________ '__ Total length Seepage Pit: Distance to nearest we -__-- Disance fm fou ation__ _ Distance to nbarest lot line _-- --- Number of pits----/---------------Lining rrateria- Size: Diameter____ ............. De th__ - s Cesspool: Distance from nearest well------_------_r Distance from foundation__________________ Lining material-------------------------------------- { ❑ Size: Diameter-------------------------- ----- Depth----------------------------------------------------Liquid CapacrtY------------------------_--gals. a Privy: Distance from nearest well___._-_______ _____________________________ �isfance from nearest building--------------------.-------------------- ! ❑ Distance tor nearest lot line-----!=------- - I �F ---------- --------- _N;` s F - Re odeling an /op re air ' describe :___ fry } -- i� "' ' -�'- =�r :-•!1. -"V--- --•-------------- - ---- ---- ; -----------'f-"---v----- `I1-1 '�1 I -------------------------- --------------------------------- � ' . ---------------------------- --- ------------------- I hereby certify that I have pr pa ed this application and that the work will be done in accordance with San -----------Joaquin County ordinances, State law , a rulesAend,'regulatio the, San Joaquin Local Health District. r� �• (Signed)-------------------.---... �' "' `-�'$ } - ----- - --------------- --------------------------- ----------- -(Owner an re Contractor) BY= �- ; /------------- --------•-------------- ----------(Title), ' (Plot plan, showing size o lot, loca iT on of system in relation to wells, buildings, etc., can be pljc on reverse rde}. i --! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ------ DATE---------- . = REVIEWEDBY-------------- ` --------- ---------------------!------------------ -------- -----------------------------•----- ------- ----- DATE---•---•---•------- BUILDING •-------•---••-----T-• ------------------- PERMIT ISSUED= .. -: i-------------- -•------- --------------- --- -------- ------ DATE------------------- Alterations and/or recommendations:--------- -- ------•---------------- ------------------------------------- ------------------------:- -•---------------•------------------------------------------:------------�J -----j--•-%,•---'� = �'-- - ------------------ - ---------•--------------------------• --- ---- -- --------------------------- ---- ------------------------------------------------------------------------ ------------ ----------------------------------------------- .----- ---- FINAL INSPECTION BY--------------4 ' AF:4 --------------- Date.. . /2 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 t�quih-American Street+t "+�m 'IN300 West Oak Street 132 Sycamore Street 814 North "C" Street Stoctf�oni California 1. A Lodi, California Manteca, California Tracy, California ES-9-21A Revi"d W-2100