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it`Na11p `•J APPLICATION FOR SANITATION PERMIT Ferm =T•-/-- - '1 (Complete in Duplicate) Date Issued --I-� d# ' a +� q, r �4 A lication is h reby made to the San Joaquin Local Health Dice strriic 5ffo9r a permit to construct and install the work herein described. ` Thisapplication is made in compliance with County [ �y �' pb U ill M l`I =•---------- - -------------------------------------------------•----------- JOB ADDRESS AND LOCATION-------------------- -------- -- ---- ----------�---- --- phone----------------------------------- Owner s Name__.------•--=--••------ ----- Address------------------•-----•-----• --- •-•------ - - --------- ---- ------•---•-------•- - - Other ❑ i Contractor's Name____________________________ Trailer Court ❑ Motel ❑ Installation will serve: Residence Apartmen# House ❑ Commercial ❑ � edrooms __2- " Number of baths ---I---- Lot size _________ �� -_ Number of living units: -------- Number of b -------------� - Water Supply: Public system F1 Community system ❑ Depth to Water Table 1-10- ft. Private Dep Prvate 4 F1 Gravel F1 Sandy Loam E1Character of soil to a depth of 3 feet: Sand Clay Loam ❑ Clay E] Adobe Hardpan E] Previous Application Made: Yes E] No p9, New Construction: Yes ElNo14 f TYPE OF INSTALLATION AND SPECIFICATION � (No septic tank or cesspool permitted if publil sewer is available within 200 feet.) � �� i Septic Distance from nearest well-__`Ja__ _" Distance from foundation ----".Mata�r---------- No. of compartments Size, X�l4 -1- ---Li Liquid d�th----------- --------Capacity------�` ---- Tank: yDistance to nearest lot line�� ------- Disposal Field: Distance from nearest well_ r_-----Distance from foundation____ - Number of .lines____,___-__ -'1-------------Length of each line-------------- 0------------Width of french._ y Type er filter material------- -/�------ Depth of filter material--------)= ---- -----Total length----------� ---- _ - +y w ofundSzen" .Distance to nearest lot ine------------------------ 0 -------------- Seepage Pit: Distance to nearest well:-----_= --'Distancefrom Size: Dept - - ❑ Number of pits---------------------kining material " Distance from nearest well------------- from foundation----___------------.din-_Lining Cat material - " gals. Cesspool: Capacity Size: Diameter------------------------------ ------Depth------------ -------------- ------- ----- ----- q Distance from nearest building____.-_------------------------------ Privy: Distance from nearest wO---•-------------------- --- -----------_ -------------- ❑ --- ------------------------------ ----------------------------------- - Distance to nearest of me________________________" f =-------•- -----•------------------------------------------- ------------------- Remodeling and/or repairing (describe)------------------ --- ---------- ------------------------------------------ T ---------------------- --- _____ __ __ ___ f I hereby certify that I have prepared this Ili the San Joaquin the workcalHeawill l be done on etn accordance with San Joaquin County ordinances, State laws, and rules andregulations t Owner d/or Contractor) 'f --------------------------------------------------------------- S! ned ( 9 -- ------- ---------- (Title}--------- ---- SY:---- (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 DATE--------- APPLICATION ACCEPTED BY. - '13 r --- ---)-5-7-3---------------------- #1 � DATE REVIEWEDBY------------------------------------------------------------------------ ------ ------ DATE_"---------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------- Alterations and/or recommendations----------------------------- __________________________ ._-______-. --------------------------------------- :�, - _/ -- - Date--- --- �7- ---- - --- - - ------------------ --- '-- --------- -- FINAL INSPECTION BY:--------------------------------� - ' - SAN JOAQDW LOCAL HEALTH DISTRICT • 132 Sycamore Str et 014 North "C" Street 130 South American Street I 3oo West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M 10-52 Revised W-21Do