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Na. "--�-�-5-�-�--- APPLICATION FOR SANITATION PERMIT Permit l i (Complete in Duplicate) Date Issued -- ---f Thisa Application is hereby made to the San Joaquin Local Health Di oct for a permit to construct and install they ork herein described. This application is made in compliance wig, County Ordinance � ---------------------------------- JOB ADDRESS AND LOCATION.__ _ " --------------- -------------•------- ------ ----- ------ ------ ----- ------------------------ Phone------------------------------------ --------------- ------------------ Owners Name------ - --------------- --------------------------- ----------.. 9 7-------------- Address----- a --- ---- Phone ----- ------ ----------------------------- - Other Contractor's Name,,-;;?4---"'- ------- Motel ❑ Installation will serve: Residence If Apartment House ❑ Commercial ❑ Trailer Court ❑ 3 �----- Lot size ---��O__" --a'l" -°---------- ------ ----- Nurnber of living units: __ ---- Number of bedrooms �____ Number of baths I. -oft Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Adobe❑ Hardpan ❑ PP y� Y Gravel Sandy Loam, Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet.I Sand ❑ ❑ FHA/VA: Yes �{ No. y New.Construction Yes No '`�' Previous Application Made: :Yes ❑ No' - - »•�••� ��'�'• TYPE OF INSTALLATION AND SPECIFICATIONS: ; f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material �� -- - ------- Septic Tank: Distance from nearest well_ .Q-----Distae`f da..L quid de0hy-------- Capacity_Iai+C -------- No. of campar#menu------ ---------------Size-- ` .Distance from foundation__�ta-'--------Distance to nearest logline--- ----------• Disposal Field: Distance from nearest welIT-0-----_Length of each line___--0-1----------------Width of trench--34-6 Number of lines____"-•--------- ° -y� -"-__Depth of filter material_".�"�-�--------Total length--,�"�jE-�-------------------------"""- T e of filter materia �� - Yp , Seepage Pit: Distance to nearest w 4____________---------Distance from foundation--- -------------•Distance to nearest lot line-______ ____- """ Linin material Size: Disameter---------------------- .Depth ❑ Number of pits_---;%^------ 9 � Distance from nearest well--------------- from foundation----- ----.Lining material----------------------- - "---------- Cesspool:Cesspool: e R; � _Liquid Capacity--------------------------•g Distance from nearest well j - from n ❑ Size: Diameter----- ------- ---- --- # -- ep ',----------------- from nearest building------------------------------------------ Distance Privy: D ❑ Distance to nearest lot' ine___--.- --- 4 � ' r , �_` - -' = ------------------------------------------------ y v Remodeling and/or repairing [describe):_____" ;;. ----------------- --- ------------------------------------------------! ----------------------------------------- s - ------------- ----------------------- •- -- - - I hereby certify that'I have sprredparreedu`a}ions lli the San Jothat the in livorocal Heal heDist�1�{n accordance with San .loaqu�n aun y ordinances, State laws, and r)e g � ; -__-(Owner and/or Contractor) (Signed).-- -------P _-- --- -- ------ ------------------------------ ;---- -----� ------------(Title)--------------------------------------------- ----------------- ------------------------ -- ----- -------- _ _ _____ ._-_____________________________-_ Y Plot fan, showingsize of lot, location of system in relation to wells, buildings,.efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ _ ------------------------------- ------- -------------- DATE_ + = - h i DATE REVIEWEDBY--------------------- ----------------= -------- j----- -t-- - DATE------ ------------------------------------------------------ BUlLD1NGPERMIT ISSUED--------------------------------- -------- --- - - -- - -----'------- ----------------•------------------------------------------------------ ---- td Alterations and/or recommendations:-____--.--.------=- ---------- " --------------------------------•---------- -•-- -------------•--------- ; j7l� ----------------------------------------------------------------------- ------------------------------------------- ------------------------------------ --- --------/ Date--------------------------- FINAL INSPECTION ;•- ------ ------- ------- ------ ------- -- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California E5-4-2M Revises 1-57 F.P.CO.