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.� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. ( � Application is hereby made q This application is made in compliance wit County Ordinance No. 5h9. JOB ADDRESS AN LOCATI N___ _-'..__ -- -- ------ --- Owner's Name---- -•-_--------- -- --------- --------.Phone_ ----•----- -------------•--•----•---- Address_ - ------------ ; �d�� _ -- ---- ------- ��---------•-"----- Contractor's Name--- - ------ A Apartment House ❑ Commercial� Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: t Residence ❑ p , Number of livin1.g units: -------- Number of bedrooms -------- Number of baths .-/--. Lot size _ ' Depth to Water Table:-0ft. Water Supply: Public* system X Community system El Private C] p _ Adobe Hardpan Character of soil to a depth of 3 feet Sand El Gravel F1 Sandy Loa [] Clay Loam ❑ Clay El ❑ Previous Application Made: Yes [I No New Construction-, Yes No ❑ 2 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted §if public sewer is available within 260 feet.) t 9 -------.Material ; Septic flank: Distance from nearest well ►✓----Distance from foundation___. Ca acit ----- No. of compartments--------9 -----------Size__ss?X _ ---- -----Liquid depth---. .--- ---- p y Disposal Field: Qistance from nearest 4 ll c±-R=-.Distance from foundation____ _0-'7---•Disian-ce'•to nearest lot line___--s -�. y�y Number of lines------------ - - Length of each line--------•`S-�'-y----Width of trench---- - ---__------------------ Y� Total length ---------- ; ----------- Type os filter material__'_ __a__-.4K-_-Depth of filter materiaL__._�___-._-`--- �� r `� Z-4. Distance to nearest lot ine---______________ Seepage Pit: Distance to nearest welltxL�-- Distance from'.afo ndation___ ______________ -�--- Size:. Diameter`'--3-�--7 7 -----Depth----1-f--------------------- Number -�---------------- Number of pits-------/------------Uning4mate6aL, ---- -__-- - Cesspool: Distance from nearest well-----------------Distance from foundation---------- -*_,_-.Lining material------------------------------------- Size: Diameter --- Depth------------------------------------------------------Uquid Capacity- �--_-_ - --� -- Privy: Distance from nearest ---- -- ---------------------- ----_-.Distancer fom nearest building_ well _.. --------------------------- Distance to nearest lot line__._.________________ _ --'- ------------- ---------- ----- El Remodeling and/or repairing {descri!be): ---------------------------------- -------------------•---•----------- ------- ------ ------ ------ ---- ---- - ----- --- I hereby certify that I have prepared this application and }hat +he work wi{l be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r Contractor) . (Signed)--- - - -- ------- -- -�-°�-*��.-- ----- ---- ------ By: .-fid' " - --•- ----- ----------------------- -(Title) _' (Plot plan, showing size of lot, location of system-.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.__ ----------------------------- ---=-- DATE-------------------- -------------------:--------- REVIEWEDBY--------------------------------- -- - - --- --------------- ----------------------- ---------------------------------- DATE_ -s' ------ BUILDING PERMIT ISSUED---------------------------------------- --------------------------- DATE------ -�-Z-,-..,--- ---------------------------- ------------- Alterations and/or recommen a#ions:______.-_-_____________________ -------------------------------------------------- - ------ ------- ----- ------------------------------- ------------------------- Z �3- .._-_._.. - Date-----------/ --- ------ -- - FINAL INSPECTION BY---------- --- ----------------------------------------------- (( SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M is-52 Revised W-2400