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^ J 1 APPLICATION FOR SANITATION PERMIT Permit No. ----- -- J (Complete in Duplicate) ' Date Issued -- Applica4,ion 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 County Ordinance No. 544. JOB ADDRESS AND LOCATION �/_--l'ITA-ka------------------------------ -- -------------------------------------------- ------------------------- /� --- ----------------•-- Owner's Name-_ f Phone- D ------ ----- , l�-1_-r ? - - 41,0A'S-------- ------------------------------ - .12 -- � a � -� ------ ' ±�-� o - --.---------------------------------------------------------------------------------- Contractor's --------------..------------- Address--- - --- - - -- ----- - ---i------ -- Contractor's Name----------------------•------- -- ------------------------- ------ Phone--------------- -------------------- ------- Installation will serve:- Residence E[KApartment House ❑ Commercial ❑ Trail r Court ❑ Motel ❑/ Other [3Number of living units: _-(_-- Number of bedrooms --4.- Number of bat h s _ Lot size __ _ _ __!-t ----------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I, Clay ❑ Adobe ❑ Hardpan ❑ t Previous Application Made: Yes ❑ 1. No e New Construction: Yes P!r No ❑ t � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material-.. 41 �, Septic Tank: Distance from nearesr well_. ---Distanccefro`rsy foundation_-l?___---__ . - 1*No. of compartments-------�--------------Size-{J 1'--T. -` ------.Liquid depth------�---------------Capacity-..- - '• 51sp`osal Field: Distance-from nearest well-- —"--------Distance from foundation_._��i7_/f---.Distance to nearest lot ® Number of lines------- ---- --- Length of each line----- �__p___�.��------Width of trench.--- ---------------- Type of filter material'$ __Depth of filter material.--.F 15.--- ---.Total length_-----.-.l.�-Q--------- --------- wellistance from foundation---------------- to ne Seepage Pit: Distance to nearest .---.-.--------------D arest lot line---_---__---__.-- _ Number of pits---; --- --Lining material--------- -------------Size: Diameter------------ --:------.Depth--------------------------------- 4^ ----- -------------Liquid.Capacity----------------------------gals. �.esspool. �, Distance from nearest well-------------- Distance from foundation--------------------Linin material-- - .-----_--____-__--- --_----__-_ ` ❑ Size:Diameter:-- ----- ----- _Depth, q Privy: Distance from nearest well--------------------------------------- ---- ----Distance from nearest building-------------_---.---.-_-_-_----__-------. p� ❑ Distance to nearest lot line----------------- ------------ •----------------------------------------- ----- Remodeling and/or repairing (describe):-------------- ------ ----------------------------------------------•------------------------------------ ----------- ----------------------------------------------------- _______ ---------------- --------------------------------------------------------- -----•------------------------------------------------------------------ -------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. _ _-----_------------ --------------------------------------- --------------- -- --------(Owner and/or Contractor] (Signed . ` ------ ------- - -------------Title--------------------------------------------------------------- By:-----------------------•-------------•-----:-------------------------------------- - _- t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I p' PA.TMENTA SE ONLY ----------- DATE APPLICATION ACCEPTED BY------ --- ------ -- ----- == ?-------------- ------------- REVIEWEDBY------------------------------------------------ ------ ------------------------ DATE-------------------- BUILDING PERMIT ISSUED------------ ------ DATE------------------------------------------------------------ Alterations and/or recclmmendations:-------------------- ----•-----------------------•--------------------------------------------------------------- ------------------------------------------------------------------------------ --,- -------------------------------------------------- .. .. ------------------------ ------------------- - ------------------------------------ --------------- ----------------------- --------•-------- ------------ FINAL INSPECTION BY: ----- ----------------- Date--- = r' ��--------------------- -------------- ----------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 S46 American Street 300 West Oak Street-_ 132 Sycamore Street 814 North'"C" Street a11{ Manteca, California Tracy, California Stockton, California Lodi, California ES--9-2M Revised W-2100