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APPLICATION FOR SANITATION PERMIT Permit No. J_ `-._7 .. (Complete in Duplicate) y�p Date Issued if k Applicakion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Count O,dinance o. 5 9 � . - JOB ADDRESS AND LOCATION '" Owner's Name . __. � �r .:= ---- -------------- ------------------------------------------- Phone----- ------------ Address ------------------------ ------•--. t rr .� Address-----------�...��- -`�•--•------ ---- - ----------•• -•---- ------ ----- -• -•-----'-------------------------�---------------------------- Contractor's Name-------- - -------• -•-- ------------------------------------------------------- ------------------------------ Phone Installation will serve: Residence - Apo&t nt'HE se•❑"Commercial ❑ Trailer Court ❑ Montell ❑( Othe� ❑ Number of living units- __�_ Number of bedrooms -_ Number of baths ---/--- Lot size ---f_0---A-.1-�--�.---I---------------------- 1 Water Supply:-Public systam` -`Community system ❑ Private ❑ Depth to-Water Table -------- ft. Character of soil to a depth of 3 feet: Sand F Gravel Sandy Loam Clay Loam El Clay ❑ Adobe �rdpan E]Previous Application Made: Yes E] No ZE]New Construction: .Yes o [I I - TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tanVor cesipool permitted if. publi sewer !s available within 200 feet r ' .__ istance from ound tion___ r d -------------- Septic ank: Distance from nearest wel_ f MP�� - ky a pa� No, of comportments--------- Size_ '_ _ -1 21 iquid deptlS___-� r_I. Capacity_____ _ _ -_ t�� / , ty Dispos Field: Distance from nearest ell6 .___"'istance from foundat.ion_j____�__ tance tonearest lot line__tef•�-__�•_______- s Len th of each line____.____._ idth of french_:________ i�.__ Number of lines-------- 9 t 1� r Type of filter mater Q �i_-",_' epth of filter material_____--- __ _ __,____Total length_____________: __________.__ Seepage Pit: Distance to nearest wel(`____________________Distance from foundation--------------------Distance to nearest lot line____-_-__________ ❑ Number of pits----------------- ---Lining material----------------------.Size: Diameter-----------------------.Depth-------------------------------- i ' Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material-------------------------------------- L ❑ Size: Diameter------ r-------------Depth-:------------------- ---------- Liquid Capacity-------_--- ------...gals. e Priv �.�a " 'Distance`frornhneaF&st well Distance from nearest building_ y;� - ❑ Distance to nearest lot line ------- " " � t ._.-_----------------------------------- Remodeling and/or repairing {describe):_____. ^'�`__________________ ------------------------------------•--------------------------•-------------------•-------- ---.._.-. ----- -------- ----•-•-- ' = ------------•----------•------------------••---------•----------------------------------------------------------- J ----------_------------------------------------------------------------- ---------- -------------------------------------•--------------------------••-------------------------- ----------------•-------------- I hereby certify tha have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and'rule s:and`regulations of the.,San Joaquin Local Health District. (Signed) = ------ ------------ -'r -------------- ---------------------------------------------------- ------------------- (Owner and/or Contractor) By:- .. -------------- -•---t------------- ------------------------------ •------------(Title)-----------------------------------------------------------..... (Plot plan, showing size of Iot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED B - DATE----" -------- ------------------------------------------- 1 REVIEWED BY------------------------------- ...... YDfATE. -------------- - _`_-- IBUILDING PERMIT ISSUED------.,-._- --------- -------------------- - ------------------------ DATE-------,.w—------------------------------ Alterations --- Alterationsand/or_recommendations:------- ------------------------ - -------------------••---------------------------------------.._._----------------------••----------------------------•- I - -- --•-------------- -•------ ------------------------------- ------ �_.--- ---- " .. FINAL INSPECT N-BY:---= - -- --- -- -- - - •--.. .. ----x-- --------- ------------------- --------------- ------------------- S N JOA UIN LOCAL ALTH DISTRICT 130 South American Street 300 Wesf=Oak-Street'•r 132 Sycamore Street Bio North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100