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APPLICATION FOR SANITATION PERMIT Permit No. .� � (Complete in Duplicate) Dots Issued 'S- /Aplica{i�is hereby made to the San Joaquin Local Health District for a permit to construct and install thework herein described. pplication is made in compliance with County OrdinancegNo, 549. J,� lrt R ANe O ATIONr ~. l.L . f ? ''' ti J ADD �� , +,_. ------------- z Owners Name------- _-�------ ---- _ - -- 7 Address--------------- - --- - -------- ------ . ---------------------------- ° ----- Contractor's Name- ---- Apartment E Commercial Trailer Court ❑ Motel ❑ Other ❑ 7 r -installation wilLserve:.-Residence �partment House ❑ ❑ Number of living units. __ Number of bedrooms Number of at}is"__ _- Lot-size'.__s-=--- - -------==----- ----------------- t' - -- ------ w-. Community system ❑ Private Depth to Water Table 4-Q ft. Water Supply: Public system ❑ Adobe Hard Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam [I Clay Loam El Clay E] Adobe ❑ P Previous Application Made: Yes El No ew Constructio : Yes [:1 No [ TYPE 01= INSTALLATION AND SPECIFICATIONS: Awlow_� (No septic tank or cesspool permitted if public sew is available within 200 et.) Septic Tank: Distance from nearest well.................Distance from foundation-...-__:- ----_.Material_...-_-_..---_..._..........__..-.-.- ❑� No. of compartments------------------ -- --Size--------------------------------Liquid depth ----------- ------ Capacity----------•------- r Dispose Field: Distance from nearest weii---.�,a. ..:.Distance from foundation... _. Distance'to nearest lot/1i�e_-...:.._- Number of lines---.--------��__i -- ----- ---Length of each line--- ------- Number of trench-----v2f---------------------- Itr 4 Type of filter materialfj _. ----Depth of filter material....-_ �---_Total length,_ __. _�----------------------•-�-- t J- Seepage Pit: Distance to nearest well----/QQ-__...__Distance from foun anon_._.. •.:..._.,D3is`t�a��e to nearest lot line--J Number of pits.-----1---------- ---Lining material------ --Size: Diameter-----.-__- -...._.... Depth.... o�x�__�----- � F Cess ook: Distance from nearest well.................Distance from foundation...-.---__-------.Lining material--------------------------------- Cesspool: . ------_.._..---..___.-.-.-- P _ Liquid Capacity -- g Is. Size: Diameter- _ -------------------- -- Depth- --- G —�- ------ ----- - 'ice"'❑ Distance from nearest'ISuilding-- --_--- ----- n Distance from nearest well ----- ------ Privy. # Distance to nearest lot line -- --------------------------------------------- = Remodeling and/or rep irin (describe _ . __ -- ,74rt 1 9 ---- --- [ - - --- -----------•---------------- -.. ---------------- ----- - --- --- i I hereby-certify that I have prepared this application and that the wort will be done in accordance with San Joaquin' oun#y 1 ordinances, State la s, and rules and regulations of',the San Joaquin Local Health District. V r (fir and/or Contractor) - - -----i rt --- (Sign -- (T' tBy: -- -•-----•----•---------------------- it ) i e P e side) (Plat plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on revers . FOR DEPARTMENT USE ONLY DATE---------- -------------------- ;. APPLICATION ACCEPTED BY--------------------------- - --------- DATE --------------- REVIEWED BY------------------ ----- -- - --------------------------------------------•----- ---- _ - � a. .. �. - ATS- = �.- - BUILDING PERM l SUED____ - ------------------------------ Alterations and/or recommendations------ ._. ---- ---------------------- --•--•-----------------------•---- ----------- ------------ ---•- ---------------- ----- I Date .. --- ------------ --- --- ----------------- FINAL ------- -- -----•----- --------- -------- FINAL INSPECTION :.--- ------ --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y r Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100