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APPLICATION FOR SANITATION PERMIT Permit No. ��' (Complete in Duplicate) Date Issued ______ 4 A lica�ion is hereby made to the San Joaquin Local etDistrict for a permit to constructed install theme herein described. PPOrdinance „x� • p ace with County This application is made �n com iia _ .; - 11 ------------------- JOB : i �t3 vp-- - �-------- L -------- --------- JOB ADDRESS AND LOCATION:-•f --- -------- -------------------------. Phone- ----------•--------------- �l L Rw Owner's Name p -------- ' ----- --------------- - - ------------------ ------------- !�� L -------------- Address...---- .� _ = ----•-------- Phone/) Contractor's Name____- .--- -------� Motel ❑ Other ❑ Commercial ❑ Trailer Court ❑ Installation-will serve: Residence [],-Apartment House ❑ /R__0 ` Number of living units: __-.____ Number of bedrooms __-7!�umber of baths -------- Lot size __-_� - ------------ grivate [�epth to Water Table.,g__U ft- Water Supply: Public system ❑ 'Community system ❑ CR--Hardpan F) Character of soil to a depth of 3 feet: Sand ❑ Grave4 ❑ Sandy Loam [IClay Loam ❑ Clay E] Adobe Previous Application Made: Yes ❑ No ❑ New Construction: Yes E] No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspoolsewer is'available within 200 feet.) 1�permitted if public se Distance from{nearest well__.-_-___-------Distance from foundation------------- ------Material___-.___-__-___ . - Septic Tank: Size ---Liquid depth---------------- ---------Capacity ❑ �:s .r No. of compartments----------------- - Disposal Fiel -=Distance from nearest well----------------DL stance k of each lin -----------------------foundation -------W dthcofttre chest lot line----- --------- ❑ �r� � Number of lines 9 -- Total len th .Type of filter material__--_____- --.:---Depth of filter material_________________� 5 . ..- I`CI� Size: Diameter__-_-�?--------------- Depth---- Dd _-----_-Distance from foundation_. ---- -- ,;ace to nearest lot ine---------------- Seepage Pit: Distance to nearest well-._�-_____ Number of pits_---------/-- -----Lining materia4 /1'------- --- --- ing Distance from nearest well-----------------Distance from foundation-------------------Linaerial ---------- ------------- gals. Cesspool: ------Depth---------------------•-------- -------------- ---- qing Capacity ---------•---------------- ❑ Size: Diameter---••- -- -- -- ----- --- - - nearest well-------------------- Distance from nearest building--------------------------------- Privy: Distance from - Distance to nearest o ine.----________-.-_-- -- - --- -------- } Remodelisig and/or repairing (describe)-- ----- ------------------------------------------------------------- ---------------------- - --_-_-_-_-------------------- - ------ ----- ------ ---------•-•--•---•------------------•---•----•----- ----------------••---•--•------••---•---------------••- ------------- -------------- ---------- -------------------------------------- prepared applicationa uin Local He - ----cor ••---------------------------------- I hereby certify that I have epareduibis s the San Joaquin the work will heDd'done accordance with San Joaquin oun y j ordinances, S e laws, and rules a g her and/or Contractor) f JY- -------- -- -- - (SignSi ed) - --------------------- ------ ( 9 }------ - - _ - (Title)---------�-- - ------ By:. - --------- - -------------- ------ ----- ----- (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---;,----------------------- __ . DAT _-. �'--- ------------------ ----------------• - ---------- REVIEWEDBY----------------------------- ------ ------------- DATE------*,=rt------------------ ------------------------------------- BUILDINGPERMIT ISSUED------------------------------------ ---------- ---••----------•------------------------------ Alterations and/or recommendations----------------------------- .----_------ -- -- --------------•-.- ---------------- --------- ...0 -------------------------------- __-A...... ------ -------- ---- Date------ - - - ------ --- ...... - ------ -- FINAL INSPECTION BY.__'------- -- -•--•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C” Street i 300 Wast Oak Street 132 Sycamore Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California FS_'9-2m 145446 PTWOOO 12-54