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__moo , � t � APPLICATION FOR SANITATION PERMIT Permit No. _._ __ ...... (Complete in Duplicate) Date Issued Applica�ion is hereby made to the San Joaquin Local Health Disc 5 r permit to cons fnd -install the work herein described. This application is made in compliance with County O ce [� ` J08 ADDRESS.A CATION_ ---- --------�- ►� ,f Phone} Owners Name------ -- -- --•---- Address. Aj+� - ------- _o--•-------- Phon ____________ _5 Contractor's Name.--A�------ - ---------- - -------------- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y = ----------------- Number of living units: __--dumber of bedrooms _11--Number of baths ___Water size _�___/_,____ --.--. Water Supply: Public.system ❑Community system ❑ Private ❑ Depth to Water Table '- ffi. �, �►■ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe d Hardpan ❑ �V Previous Application Made: Yes ❑ t No [ New Construction: Yes ❑ No ❑A. wry i TYp FINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti4 ° Distance from nearest well_________________Distance -------------------------------------------------- from foundation-------------------- No. of compartments--------------------------Size------------------------------ Liquid depth Capacity p� F1el Distance from nearest well__________________Distance from foundation-------------------- to nearest lot line----------------- Number of lines-----------------------------------Length of each line--------------------- ----------------------- Width of trench ---- Type 'of filter material______-�__ii________________Depth of filter material___________A�--Total length___-.____--.____._____________.-___�__ ' Seep ge Pit: 4 Distance to newest well�l@tikF1-----Distanc fr f undation__��_-___.___.Distae to nearest lot lin _ ____.__ Depth..2�-------- ------ t I- -Size: Diameter_a ____..._ -. Number af.pits-____0_______________Lining material _____._----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.----.Lining material-----______-__._--------------- els. ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------- --.Liquid Capacity--- --------------------9 I Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building---------------------------------------- - Distance to nearest of line---------- ------------------------------------------------ t Remodeling and/or repairing (describe):-------------- ---------------------- -------- -------•------ ---------------------------------------------------------------------------------------- I her eb certif t I have prepared this application and that the work will be done in accordance with San Joaquin County- ordinances, State la s, nd rules a d regula+io s of the San Joaquin Local Health District. j Contract [Title{ cs f (Signed) _�._(__1.�'_ -- --- l2 - ----------------------------------------- BY� - [Plot plan, showing size of lot, location of system i re ion to wells, bui ings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY ------------ APPLICATION ACCEPTED BY_ ------------------------------------------------------------------- DATE:`- REVIEWED BY DATE_ ------ DATE---- BUILDING PERMIT ISSUED------------- •--------------------------------------------------- - Alterations and/or recommendations--------------------- ----- ------------------------------•----------------------- ---•-------- -----•-----------------•--------------•------- ------------------------ --- --•-------- - --------- • J% f� j--?i Date--------- FINAL INSPECTION BY:---------- _------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Syeamore Street 814 North "C" Street 130 South Arnerican Street Trac California Stockton, California Lodi, California Manteca, California Y. Es-9-2M Revised W-2100