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Permit No. 4 APPLICATION FOR SANITATION PERMIT q '3® (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local HealthDiNoc for a permit to construct and install the work herein described. 4 This application is made in compliance with County Ordinaoce ., 49. ---------------•------•-- ---- JOB ADDREAND LOCATION.... ---- Owner's Na -f --p --------------------f•---••------- ------------------------------------- -------------------------- Owner's ---- --- Phone .._..-- Address. /tCJt` -"'(�- hone..:--i- Contractor's Name---------� -# Other Installation will serve: Residence GVApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ ` K CO--------•--- �_-- Number.of baths _-�___ Lot size _--1 Number of living units: ---I_-_ Number of bedrooms -_ - Water Supply: Public system R3" Community system ❑ Private Depth to Water Table�` ft• Adobe arpan ❑ Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam El Clay ❑ Loam Clay [3 �H Previous Application Made: Yes'[] No ❑. New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet-]/ ` Septic Tank: Distance from nearest well_--�V------ e �r{om foundation uid depth-M�}t9*`a-----------Capacaty..�d b ® No. o{ com artments-----__ --------- ` from nearest wel . .d_-- __Distance from foundation---2-4'_ -- ----Distance to nearest lot line--__�-_---- Disposal Field: Distance ` f)-0 Width of trench--___. -y-•�--------- �/ Number of lines-------------- ------- Length of each line--- �y I Type of filter material: tnE ___-_---Depth of filter material_-_.J_$'------------Total length------.. near Seepage Pit: Distance to nearest well-------_-------------Distance from foundation-----meter-- Distance to Dept h_ lot line----------------- Distance -----_-----.: p� P Number of pits._.__.------�--------Lining material - - ` ------------------------------- Cesspool'. Distance from nearest well-----------------Distance from foundation.__.__.--.---- --�. u Lining Ca eacit gals. ---.Depth q P_ .Y _ _ r ❑ Size: Diameter �� - - Distance from nearest building__ Privy: Distance from nearest well----------------- ---------- to nearest lot line----_------------------- ---------------------------------------------- Distance - ------------------- 1 :. 'Remodeling and/or repairing (clescribe):.-------------------- ------ --------- -------- ------------------- ------------------------------------------------------ - --------------------------------------- I ------------------------------------------------ --------`'- ---aced his application and-•that the work will be done in accordance with San Joaquin County hereby certify that I h i� p p q i-"-` ordinances, State laws, and r, s nd re lotions of the Sari;:loa uin Local Health District, z and/or Contractor) ---=---------- ----- ------- 9 � --- -------------------------------- (Title)- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY DATE------- - --------------------------- APPLICATION ACCEPTED BY----------------------- DATE ------------------------- REVIEWED BY----------------------------------------- -- ------ - --- ------- ------- - DATE--------- ----------------- ----------------------------- BUILDING PERMIT ISSUED--------------------------------- ---------------------------- ----------------- -------------------- l Alterations and/or recommendations:-- -------- --------- ------------------=-------------- ----------------- - ----- ---------- -- --•-----•------ - -- FINAL INSP N BY: - •� --------- ------- - - - Date... ---- ------�------� •- --- ------ --------------------------- SAN ----- -------- ----SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M Revised a.'59 F.P.Co. - -