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rAPPL1CATION FOR SANITATION PERMIT Permit No. �=�-- i D in Duplicate) [Complete P� � bate Issued ---•--- -------- -- I Health District for a permit to construct and install-the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ord' nce No. 549. 101i/:u ------ JOB ADDRESS AND L ATl N --- ____ 4�--- ----- .,...- Phone `5 Owner s Name--------------- - --- ------ ------- ------------------------------------ Address ----- i ------ ----------- -- -- - - - pp -`----- ----------------- -- Phone. L-_ - - Contractor's Name______________c.� - - - ---------------- - Installation will serve: Residence A artment.House ❑ Commercial ❑ Trailer Court ❑ Motels ❑ Other ❑ C� p ' ` _ Number of baths _-/- -- Lot size _-��--�-l�-g�-•---------- ------------- Number of living units: f----- Number of bedrooms _cam r-- Water Supply: Public system [Community system ❑, Private El Depth to Water Table ys. ft- .� Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam 11 Clay E] Adobe Hardpan ❑ , INo ❑ Previous Application Made: Yes f-1No [ New Construction: Yes ❑ No FHA/VA: Yes ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or'cesspool permitted if ublic sewerisavailable within 200 fe/et.) �� Distance from foundation 1_ ------Mat`ial� �', / " Septic Ta k: Distance from nearest well/_�!"-�- ------Size - ---- Ca aci p�� No. of compartments____.._._ s�lP - -----Liquad depth_-_:� �� ------ p rY o D'spasaI Field: Distance from nearest well2 ---.Distance from foundation-_��----------Distance to nearest lomat Mine________ Number of lines- Length-------'- - Length of each line------ --------------Width of trench_-- -7---, i - /- ------------------------- i Type of filter material__ � -Depth of filter matenai___�.�_____%`__Total length_.____ ._ � ^# s: ,_ _.___.Distance to nearest lot line___`S_-_---. Seepage Pit: Distance to nearest well'/LQN C'/___--Distance f foundation__ eV Number of pits------/--------- --Lining material___ _ -.Size: Diameter-----3.- ---------Depth---v -`5---------------------- Cesspool: Distance from nearest well------------------_Distance.from,foundation------------------- Lining material-------------------------------------- ----------------------------------------------`-----Liquid Capacity- -------------------------gals. ❑ Size: I.3iameter-�--------- -------- ---------- -Depth i 1 ___.__-_Distance from nearest building__-___----------------------------------- Privy: Distance from Iearest well------------------------------- ❑ -------------------- ------- Distance to nearest lot line__________--------------------------- - Remodeling and/or repairing (describe --------------------------- --------------- ----------------------------- t - ------------------- ----------------=--------------------------------------------------------------- f I � . --------------------------- .. -- ---------•---------------------•--------------------- --------_-=------------------------------------------------ ' _ s pplication and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this a ordinances, Stat sand rules a d re lations of the San Joaquin Local Health District. [Si 9 ned) [Owner and/or Contractor l ---------- . --- - tiT By:_------ (Plot plan, showing size of lot, location jyfern in relation to wells, buildings, etc., can be placed on reverse side). I I . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------- DATE--------------- � 4------------------------------ -- --- -- - .� - •----- - DATE--------�------ ------------------------------------------ REVIEWED ----------------------- ------------- - REVIEWEDBY--------•-----r----------------- ----- ---------- - -- ---- ------------------------------------- - ------------- DATE--------- ---------------- ----------- ------------- BUILDINGPERMIT ISS.UED----------I------------------- ----------------------------------------------------- Al+erations and/or recommendations_____ ___________f-___--_----------------------------- ---------------------------•------------------•----------•- ----------------------------- --- ------- ,ti ---- i _ - -- _ ____._._ ---------- ------- _________ _______ ______..__ - ---- ------- ------ -------------------------------- T E ' / ------------------- �� 1,14 FINAL INSPECTION` BY:. ----------- -------t 11L, Date--- SAN JOAQUIN LOCAL.HEALTH DISTRICT ' $14 North "C" Street [30 South American Street 300 Wes+ Oak Street 132 Sycamore Street fLodi, California Manteca, California' Tracy. California Stockton, California - ES-9-2M Revised 1.57 F.F.Co•