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PERMIT APPLICATION FOR SANITATION Permit No. . -----•------- 1 (Complete in Duplicate) �O p ] Date Issued _-_- -oZ-------- �� A�cat�on 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 Ordina[n�ce No. 5Q49. TION__. I --- �--- -`---rh -------------- '*-'' JOB ADDRESS AND LOCA __- Phone---------9_--__j_1j-_2------ Owner's Name---------- Address------------ Phone�/= ' 1�-r ------- �l 7 Contractor's Name------------------------------ Gommercial ❑ Trailer Court ❑ Motel ❑ Other Installation will serve: Residence /g Apartment House ❑ � �-- Number of living units: _tNumber of bedrooms __-%/Number of baths __/-. Lot size Community system 11Private Depth to Water Table .---"--- ft. Water Supply: Public system 0 ' Clay Loam C1 Clay E] Adobe Hardpan [ICharacter of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam El Previous Application Made: Yes ElNo + New Construction: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank or cesspool permitted if public sewer isavailable within 200 feet.] lMateria----------------------------------------------- Distance from nearest welL_______________D�stance from foundation_.___.______.-_ _.*No No. of eompartnients.. Size----------------------------•---Liquid depth--------------------- Capacity a Field: Distance from nearest well15S - �enat ofreach I ne_ncla �n- -W dthc°fttre cheste_�__�.1-.___..-_ i Number o? lines-------/----. .-. g !' Total len th_---------�--lJ Q if y; ; Type of filter material____l a----y Depth of filter material__.____._` _ ---- g :. Seepage Fit: Distance to nearest well----------------------Distance from foundation_.___--------------.Distance to nearest lot ine-------"--------- Number of its------- --------------Lining material-----------------------Size: Diameter------------ Depth i ❑ p ___________ Cesspool: Distance from nearest well_--_--._-.-_-__-Distance from foundation-------------------- Capact gals. ❑ Size: Diameter--'------r-------- --------------- Depth "\1 Distance from nearest building-------------------------•--------------- '" Privy: Distance from nearest well-- ---- -------- ----------------------------- ❑ Distance to nearest lot line-------------------------- ----------------------- ------------------------ Remodeling and/or repairing (describe):____ -. ,-- - ------------- -------------------------------------------------------------- -------------- -- ---------------------------•------- -----------------------------------------------------------i •------- -- -------- ------------ I hereby certif that I have p ared this applicat on and that the work will be/done in accordance with San Joaquin County ordinances, State law nd rules an re Mations of t San Joa ' Local Health istrict. ----------------------------- (Signed) ------------- ---•--- Contractor] (Signed)--- ---- - -- -------- -------------- ------ - can be on reverse side). (Plo+ plan, showing size of lot, location of system in relatio to ell's-buildings, et , p cad ( FOR DEPARTMENT USE ONLY ,} DATE- f/ "' ---------- APPLICATION ACCEPTED BY------------_ ___ _____ ------------------- ------------- ------------------------------------ ---------------------- DATE--------------- -------------------------------------------- I!REVIEWED BY---------------------------------------------- --- DATE -------- --------...------- - ------------- - BUILDINGPERMIT ISSUED------------------------------ --------------------- --------------- ----- -------- -------•------------------------------------------------ Alteretions and/or recommendations------------------------ ----------------- ----------------------------------------------- } ------- I. ------------------------------ --- ------------------------------------- I ..-___-- ________..____ ___________""--- -- .__--_.._-"___________________________ ___________________ _ �� -------------- ----- --- : : ~ Date--- ---------- Y------ FINAL INSPECTION B - --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Stre t 300 Wast Oak Street Tracy, California l30 South American Street Manteca, California Stockton, California Lodi, California ES--9-2M I0-52 Revised W-2100