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�1 �� -' APPLICATION FOR SANITATION PERMIT Permit No_ _______ _________ ____ J (Complete in Duplicate) - � ... Date {slued ----•--�------- ------ Apprca�ion is hereby made totheSanlioaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance . 54� �I F = //}} , i JOB ADDRESS AND OCATION_----1l 1---_11 -1---- - ;© _ ----- I------------- Owner's ---- ---------------- ----------------------------------------- _ 7 ' Phone Name_____ _ Address-----------------•-•--------- ------- ' F --•--- Phone Contractors Name----------- -- --- -- •• --- - -- -------- ------- -----------'---- Owl Installation will serve: Residence Apartment Hou sei ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 Number of living units:----/--- Number of bedroom_-- Number of baths _:. __ Lot size --- ----1< ---------- Water`Supply: Public system ElCommunity system El' Private [ epth to Wafter Tableft. Sandy Loam Clay Loam Clay ❑ Adobe rdpan ❑ ti Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 5a y _ ❑ y ❑ Previous Application Made: Yes ❑ No-"w Construction:.Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) c T Distance from nearest well-----------------Distance from foundation-------------------.Material------_--:------------------- Liquid depth--------------------------Ca acit -0-of compartments----------- --------------Size__.----------------- `--- ----------------------- i osa F, ;:�_�Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__________--.____ Number of lines---- ---- -----;Length of each line------------------------------Width of french----------------------------------- Type of filter material-___ _Depth of :filter material______________ ____ Total length_-_-_______-________--__________-_________ ' -__.Distance to nearest lot Ii 1-4_ _. a - f ____Distant r fo dation____ /I � � Seepage Pit: � Distance to nearest well _! ---•• g �. -Size: iameter > De tn_ Number of pits..---�------------- mm material- _ _ - -- - P � --------- ------ f Cesspool: Distance from nearest well-----------------Distance from fo ndation------------------. Lining material---------------------------.-------- . 4 ❑ Size: Diameter--------------------------------- - ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. M r 4 Privy:k Distance from nearest well---------------- Distance from neares+ building--E--------------------------------------- Distance to nearest lot line:_ "' ------=-------•-----------------•----------------------------------=------ `------------------------- ❑ ---------- Remodeling and/or repairing (describe)--=.................... -------•--------------------------------•------------------------------------------- ---------------------------------------------------------------------- --------•----------------•-----•--------------• -------------------------- ------•--- -----••----------------------•-----------------------•------ -T I hereb cerci atpl have prepared this..apPlicati and = = ----• ------------•---'cco--- -----a--n- u--i- n -- I y +h ' the work will be done in accordance with San Joaquin ounty ordinances, S+ a laws, an ules and regui tions of the J quin Local Health District. (Signed)--- Contractor] Title (Plot plan, showing size of lot, location of system in relatio o wells, buildings etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --- DATE------------------------•-------------------------- ------- DATE---- REVIEWED BY----------- BUILDING PERMIT I�SUED_4-----------------------------, ---`--'------- ---=----------------------------• --------------- -• DATE....'-�-_'=`----------------------------------------------- -112 AltPrations and/or recommendstions-------------------A =--------•----.------------------------------------------'= �-- -------- ----------------- ` /1 -�tt�-tom 1 .r -•w # �a f+ . f '*' 'r'x�a+s• t 't � ----------- ----------------- -------- ------------------------------ ----------- 3: . --------------------------- ------------------ FINAL INSPECTION Date--.l 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 ,S-4--2M ; - Revised W-2100