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APPLICATION FOR SANITATION PERMIT Permit No. -- -•- a r (Complete in Duplicate) Date Issued -r •�° A lication is hereby made to the San Joaquin Local Health DiNoc for a permit to construct and install the work herein described. This application is made in compliance with County O 49 - ---------------------- ------- � '�-- -- ------------------- SI!Ff . JOB ADDRESS AND LOCATION / ~x -------- Phone------------------------------------ Owners Name. { -. ---•---- ---------------------------- Address r --------------- Contractor's Name-------- •---- ------------------------ --------------------y» = Other Commercial ❑ Trailer Court Q Motel ❑ ❑ I Installation will serve: Residence Apartment House ❑ Is . ` Number of living units: ___,---- Number of bedrooms .A--- Number of baths ---I--- Lot size ------------------- Water Supply: Public sys#em_` �} Community s stem`❑ Private ❑ Depth to Water Table :_:_-__ ft. pP Y: y_ Y -�� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy�Loam ❑ Clay Loam ❑ Cay ❑ Adobe ] Hardpan ❑ k E New Construction: Yes ] No ❑ ` E Previous Application Made: Ye�`No , i 1 y +,o,,, INSTALLATION AND SPECI�IGAT90N5: TYPE OF INSTAL , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / .Material--------%A__V4d-d------------------ - Ca acit fr�D Septic Tank: Distance from nearest well_____ __.. �___Distance from foundation______ � No. of compartments------------ 2: ....Size---------5X-1--r-3----Liquid depth------. .I-- -- p __1 •---- 5/----- 1 Distance from foundation___-___� _.___Distance to nearest lot line--- Field: Distance from nearest well..- -,--- D 3p Width of trench-__-___-�yI/-.---- ------ pol Number of lines_________________ 1 Lenpgth of each line___-- 1( --- --�,------ / s� 3 1�It Type oz filter material________.�______________De Depth of filter maternal--_.__Z$__--------Total length__.-___.____. .-�--------------••---- Seepage pi�: Dis#ante to nearest well________----_________Distance from foundation----_------- _.Di ante toDneep{fist lot line----------------- rest -------------- •� Number of pits----------------------Lining material____-.___. Distance from nearest well-___--'____-____Distance from foundation-----____________-.Lining material__.____._-____.__------- .--.--- Cesspool: Depth -Liquid Capacity--------------------- ------gals. ❑ Size: Diameter-------------=------ p ' _ i . .,. .� g------------------------------------ ---- Privy: Distance from nearest we4L-----k--------------------------------------- Distance from nearest,b'--- in ---------------------^--------- ❑ - .._ = Distance to nearest lot iine__ �___�-- , r».•� ------------------•--------------- ------------ Remodeling and/or repairing (describe)------------------ - ----------------------------------- } - ---------------------------- -------------------- ______________------------------_____________________________________________F.___.------------ _ _ ___________________________________-------------------------------------------_____ ______i__________________________________________________________________________________________________________________________________ ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin.County ordinances, State laws, and rule and egulations o t a San Joaquin Local Health District ---__-.___-(Owner and/or Contractor) - ----- ---------- (Signed}._� _ ------------------ -------- -------- --------- ------- --- BY� --------------------------- ------------------------- (Tit e etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in'relation to wells, buildings, FOR DEPARTMENT USE ONLY DATE---------------- 7 �/ ---------- APPLICATION ACCEPTED BY---------- --------- ----- ------- ------------ DATE -- --------- ------------------------ ------------•-------- REVIEWED BY_ = DATE---------------- BUILDINGPERMIT ISSUED---------------- ---- ----- -------- -------------------•-------•--------•--------------------------- --------- ---- Al#erations and/or recommendstions:__...___________._____ _•__,•---..-..._ ---------------------------- - - ------- ---------- -------------------------------------------- ---------- -- V " � Date - --- f FINAL INSPECTION BY------------------------------ 9 SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street $14 North •'C" Street 130 South American Street 300 Wast Oak Street Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M 10-52 Revised W-2100