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�v 'APPLICATION FOR SANITATION PERMIT Permit No. __..(Q-U- -------- (Complete in Duplicate) Date issued Applica{ion is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in,compliance with County Ordinance`No. 5 9. •------------•------ --�--- ------ . JOB ADDRESS AND LOCATION-J!--- { Owner's Name------ ----- -----• -- ----------- - ------------------------- - ---------- Phone------------------------------------ t Address----------------- � -------- ' ---------------------------------- ----------------- - - -------•-- Phone------------ •----------•-------- •-- -------------------------- ------------ ------------- ----- Contractor's Name--- --•---- --••----...:---------�•------------------------- ----•--- Installation will serve: Residence L*! Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑rcOth r,❑ Number of living units: ._--- Number of bedrooms _. __. Number of baths - Lot size -------.�--- ------------------- t. Water Supply: Public system'❑'"Community system private ❑ Depth to Water Table - a ft. Adobe[Hardpan [3Character of soil to a depth of 3 feet: ❑Sand Gravel" Sandy Loam i Clay. ClY ❑ Previous Application Made: Yes F1 , No New Construction: Yes g No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool }iermitted�iAT ,u blit e, er is available within 200 feet•)j� Mafieri 1Disfiar� fr fo ation v----------- Septi ank; Distance from nearest we � Li uid ale #h-.. __.___ ..______--Calpacity__..- -- - y, No. of compartments----- ---- ------- - Size------------ - q a p. ,t. tf ��e yr Disposal Field: Distance from nearest wel �Disfiance from found tion----------------- Distance to nearest"lot IFn ..� �� --------•-- Number of Fines--------- --- --•- -- =Length of each line _---^'-°----� if ---Width of trench.--------- -- yy__ Je th of filter material.__._f- ----- length----_________�- -� �" Type of filter mtermly_ P e i Seepage Pit: Distance to nearest well________ ____________Distance from foundation---------------.__..Distance to nearest lot line----------------- 0p F ❑ Number of pits--------------------- Lining material_--------•-------- ----Size: Diameter------------------ ---- Depth--------- ---------------------- i Cesspool: Distance from nearest well___--.____._.---Distance from foundation._.__..______.._--Lining materia_____________________________________ --De th----------- -- ------------------------ Liquid Capacity g {: ❑ Size: Diameter---Y-='"--- ------- -------- ----- r� - 1 : Distance from nearest'building------------------------------------------ Privy:. Distance from-nearest.w(A-- ----------------------- ❑ Distance to-nearest lot ine---____----------------- , a _a 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 andrregulatio of he San.Joaquin Local Health District. - eJ_-------------------(Owner and/or Contractor) S. ned ------ - : -----------(Title)-------------------------------------------------------------- ------------------ - ------ - -- ---- -------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY DATE,�------------------------------------------------------ APPLICATION ACCEPTED BY_ DATE__. REVIEWED. BY------------------------------- -------•---- --------- DATE--- -- -- ------------------- -- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- -- ...------------- --------------------------•---------•----- Alterations and/or recommendations---- ---- ----------- =----- -_----------------- ------------------ ------•-------------------- -------------------- --- ------ - - - ------- - -- - Date__..-------- ------ F1NAL INSPECTION BY:---------=------^--•-----.""----..="----•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" 5+teat 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES—g—ZM 145446 nswnno 12-54