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• APPLICATION FOR SANITATION PERMIT Permit No __� (Complete in Duplicate) �a rt Date Issued .__ _____ Applica{ion is hereby made to the San Joaquin Local Health Di ��- This application is made in compliance with County Ordinance No. a permit to construct and ins+all the work herein described. JOB'ADDRESS AND LO ATION Owner's Name__"_ Address Phone •---------------•--------- ---•-------- --•--•--------•-------------------------- Contractor's Installation will serve: Residence � """ -""•"------"-""--�-�"`---""`"""-- ----•----- Phone �"•"- Apartment House ❑ Commercial Number of living units: _ , ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of bedrooms _ _.- Number of baths -"" Water Supply. Publics stem L- Lot size ------1, _sg��,d� _ PP Y� Y ❑ Community 's�stem Y Y ❑ Private ❑ Depth to Water Table __ ft. Character of soil to a depth of 3 feef: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe Previous Application Made: Yes Hardpan ❑ ❑t No 'New Construction: Yes ❑ No e�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank; - � p Distance from nearest well-" 'Distance from foundation_-"1P No. of compartments --- --- -----Material___.-__�.''. ----- Size----- --------------------------Liqu'd depth------------ - " -- ----------------------- Disposal Field: Distance from nearest well._- pistance from foundatron_ Capacity_.______---_ ��__'.__Distance to nearest lot line_-- Number of fines-------- / " " " Length of each line_=_---& " Type of filter material_ �� -------Width of trench-- ---Depth of filter material.."--.IC... __ "--------- Seepage Pit: Distance to nearest well"_-"- Total length ------------------------------- Seepage =Distarice�from�foun ation__9 -'r-----Distance to nearest lot line___ _f. Number of pits-_ . ---------Lining material_ 4'A+ize: Diameter__- Cesspool: Distance from nearest well______-______ � ---------Depth--------t7 ` • ___Distance from foundation___.__""--"-_-""_"" Lining material_-.-" ❑ Size: piameter.__--_._"._-". ❑ Distan -- -------------------- Depth--------------------- ---------------- --- Priv r Liquid Capacity - --------------------*gals. .._Distance from nearest buildin • istance from nearest wellg ce to nearest lo# line---------- --4-:Z Remodeling and/or repairing ( -•------------------describe):_ - ------------•-- 4 ---- -• - -. . ------------------ ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San ui Joa ordinances, State, laws, and rules and i•e lations of the San Joaquin Local Health District. Joaquin County (Signed).__ I - --•--=---------- ------- --------------------------------------------------------- By:----------------------•-- Contract (Plot plan, showing size o +, Iota+ion of system in relation to wells, buildings, etc., cantbef pl cn rave sid r s e). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ---- - ---- ------------- ------------------------------------------ REVIEWEDg ---------- ---,, DATE PERMIT ISSUED. DATE- ------- Alterations and/or recommendations:-- ----- ------------------------ --------- -------••--------- DA - --- - ------ - b ------ --•----- ----------- -•--- -- �' f --- - -- -- ----------------- 1 ----------•-- --------------------------- -- --- ------- ----- - ------------- FINAL INSPECTION BY: Date------ - f" SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street Stockton, California Ma 814 North "C" Street Sycamore Street I � Lodi, California Manteca. California ' Tracy, California ES-9-2M 7a54 46 ATWOpp 1=_94