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lrlyo ( 7 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) etre Issuedon is hereby made td'the Sap Joaquin Local Wealth District for a permit to construct and install the wok he ein d tribecation is made in comp?ian 6 with Count OFdinance No. 9- �� JOB ADDRESS A -, - � 4_�e , •• Owner's Na a------- -- - -'- _ ••-- --- --- -- - --- _ _____ __________ _____ _ h i f P orte_ t_-/ G� Address ----•-- -�-- - - --- •------------• ------•------------ Contractor's Na q-, - '� ----------------------- Phone----•----; Installation will se ve: Residence Apartment H rise ❑ Comm/De Trailer Court ❑ Mated [❑ Other ❑ Number a living units. __�__._ umber of bedr oms o __ Numths I---- Lot size __c:5 '- r1 ' Water Supply: Public system Communitg•'system ❑ Privateh to Water Table` ------ft. Character of soil to a deth of 3 feet.. Sand ❑ Gravel ❑ Sandy Lo;PN'o Clay Loam ' Clay ❑ Adobe [I Hardpan E]Previous Application Made: Yes F1 �o VC� New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if ubVc.sewer is available within 200 feet ] Ltc" Septic ank: I Distance from nearesr elfd_ t,r�►✓ �� , istance from foundation___ Material_-__ No. of compartments____ --._- } .. ii i)e-------------- depth, : =------------- --------- Capacity Dispos I Field: ' Distance from nearest IiQ '�!- t" �,.,,,� istance from foundation_--�0-- 'r__.Uistance to nearest arest lot line�_/_ � � Number ill fines--------- --- - -------- Length of each line--------------- -- it Width of trench.-------'-Z.yL�� 8 Type of filter mate fTg ---- --_______ epth of filter material-________ ___ _______Total length_ � ----_--------_- Seep�a,g/e Pit: Distance to nearestlwell._._. ---------Distance fro foun iation------ _____.Distance to nearest lot fine_._ -�- 1� Number of pits..---__ J__--___Lining material__C-C 3 'r r , Size: Diameter-_- _-- -------De' --- Gesspool: , Distance from nearest well __Distance from foundation--------------------Lining material--.--------------------------------- F1Size: Diameter------- ------------------------------Depth---------- ------------- ----- - - - -- -- - Liquid Li uid Capacity ---------------gal:Privy: Distance from nearest well--- from ^> near ST f Distance to nearest1ot"1i6e7.__ ..___. : � -� - - --- � _„.,.,,_ ------ -----------------------------------•- ----,_------------------- Reru6deLftand/or re iri e ibe)------------------------ --- --- ----•-- --------------------•----------------•------- ----------------------- ------------------------------- --------------------•------------•--------------------------------------------------------•---- - ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)._-___---f_/-� r�---- - - -- --------- -------•------------- BY: _ ___t--Q d- ------------------------------- --------(Owner and/or Contractor) - = � * (Plot plan, showing s' of lot, location of system n relation to wells, buildings, (Title]__ , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATTION'ACCEPTED BY_ ___________________ DATE _________,_ -__. REVIEWE --j- D - --------------------------------------------------- DATE__BUILDING T ISSUED-------------------- - Alterations and/or recommendations:__-__-_- V_t BATE_______ __________ - •---------- - -------------------------- -------------•--- _ ----------------•----- ------------ ------------- ------ -------- - ---�------------------ - -- ------------------------------------------------------------ •----------------------- FINAL INSPECTION BY:----- -------- &3r, �' -- bate-- ------------ - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES--9-2M 10-52 Revised W-2100