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at,�. �i11 `A APPLICATION FOR SANITATION PERMIT Permit No. ._.. !__ . _.._._. (Complete in Duplicate) Date Issued .___r(./.-- Applica-'ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54.4. f JOB ADDRESS AND +LOCATION__---------- 7 -- ------------- ---- - ----------------------------------- Owne_r's Name----, l" ----------- - - -- -• - -----------=- -=- --------g ----------- -; -----------_. Phone-------------------••---=---------- Address- ---- . ------ - -------------------------------------------•------ - --------- � P Contractor's Name-----�--F--��- � ---=--------------•--• --•------------------••-------- Phone._.. __�.-----------•--•Q- s Installation will serve: ;:Resilience E� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�.____ Number of bedrooms __'"Number of baths ----/_ Lot size _ _ c1--_______________ iw 6te' Depth to Water Table Zr_. Water Supply: Public system ❑ Community'sys#em �, Pn a ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No#o, New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta tante from nearest well-----------------Distance'from foundation-----'--------------Material__________-_____---___-_-_-__..._______----_____. ❑ o. compartments------------------------Size--•-----------------------------Liquid depth---------- --- - --------Capacity-_----•---•---------- Disposal Field: i"lance from nearest well--------------____Distance from foundation___________"_____Distance to nearest lot line--------------- F-1 um- r of lines----------------------------------Length of each line------------------- ,-----_:----.Width of trench----------------------------------- Ty'e of filter material__________________ ____De Depth-of filter material--------------------------_____Total length___________________________________-___` Seepage Pit: Disance to nearest.well::_r �l '_____:Distance from foundation__:_____ f i . . �- ��._..Distance to nearest lot _. _ line____j`_---_l�__._ �-Fimh-ie: Diaeter � �--.�------ Number of pits.---- .........Liningmaterial-e-.�___.___ f --_ O- Cesspool: Distance from nearest well_________________Distance from foundation___,,_;:--_____._.Lining material______________________._._________ ❑ 5ize: Diameter_ -'------------=------------ }Depth Liquid Capacity gals. Privy: Distance frorn nearest well----------------------- •-----------------Distance from nearest building-'--------------------------------------- ❑ Distance to nearest{lot line__.__=_-__ 1.. ""' ` ` ---- ---------------------------------•-------------------•--••------------------------------------------------------- ----------- Remodeling and/or repairing (describe)___________________________ -----------------------------•----------------------------------• ---------------------------------•------------•-•---- 1 z ' Ihereby certify-that I have prepared this application and that the work will be done in accordance with San Joaquin County d. regulations of the San Joaquin Local Health District. ordinances, Stat ws, and rules am t.r � (Signed)-------- ----------G2-1 ------L - -- ---'---------- -----k ----------------------------------------_-- --Owner and/or Contractor} By:. --- XML-z ` y Gr✓___ '-e► ' dam. (Title) -------------------------------- [Plot plan, showing size of lot; location of system in relation to wells, buildings, eta., can be placed,on reverse side]. s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - M - ------ -- DATE------------ - = REVIEWEDBY---------------------------------------------'----------------------�-------------------------------•--------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------- --`------------------------ ---------------------------------•------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations: `=------------- -----------------------------I........------------------------- --------------•-------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------- ----------------------------------------------------------------------------------------------••---------•---••---------- ------------------ ----------------------•----.•.......... ---------------•----- -------------------------------------------------- ---------- FINAL iN5PECT10N BY: _'= -!1_- -------- Date--�. = ` _..:. .� SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street s 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy,.California ES-4--2M Revised W-2100