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No. APPLICATION FOR SANITATION PERMIT Permit -:----_ W (Complete in Duplicate) f I I � Date Issued AppIicatio s hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appli anon is made in compliance with County Ordinance No. /5449. JOB ADDRESS AND LOCATION---- -------q-0- _----------- Owners Name-------1V ---- ---= Phone Address----....... , __ ..-./ '----- Contractor's Name L ----------------. Phone------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ do, Number of living units: ----�__ 'umber of bedrooms .._ Number of baths - ... Lot size ____--771----y--�-e-----------------t------._--_ 4 Water Supply: Public system [✓Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe /Hardpan E] I Previous Application Made: Yes [j No VNew Construction: Yes No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publiclsewer i available within 200 feet) -.. Septic ank: Distance from nearest well0------_ istan from foundation_-� ater ---___-- -__ [ No, of corn artments--.--_-_-- - Size ._1 VOX4----Liquid,depkh-- -------- ---. .---Capacity_ 6s Q...,_ p Y�� i "Dispos Field: Distance from nearest we€�Q__,+,^![Ts�ance from found8tion'9 Distance to nearest I��jjt l e� [ 1 Nukmber of {fines_________ ______ ----__-----Length of each line--- -----�- - -e�__---Width of #rench-.---- t _. .� Type of filter maters - ` Depth of filter material------1_ _._--.--.-Total length-----------��1�-__--_ ---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--_-.----.-----�; ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------.---•---.-----Depth------.----- __----------------" Cesspool: Distance from nearest well_---------------Distance from foundation____.-.------------Lining material------.-.__---.------.-------.---.-- 'I ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_----------------------=---gals. - i Privy: Distance from nearest well-----------------------------------------------_..Distance from nearest buildin ❑ Distance-to nearest lot line---------- {------------------------------------------------------------------------------------------------------------------------------ i . : i Remodelingand/or repairing (descri€�e) ------ I--------------------------------------------------------------------------------------------------------------------------------------------- r -------------------------------------------------------------------------------=j------ ----------------------•------•-----------------••---••---------------- ------•-------------•--------------------•---------------- � ' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local'Health- District. (Signed)--------R--- ---� --- ------------------------------- --- ------------------------------------------------- ------------------:--(Owner and/or Contractor) 11 ( By:--------------------------------------- -------------------------------------------------------------------------------------------(Title)-------- ------------------------------------------------------ (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-_ ---------------------------------------------------- REVIEWED BY----------------------------- DATE �---- --------------------------- BUILDINGRERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------k#--------------:------- ---------------------- Alterationsand/or recommendations:_--------- --------------------------------- ------------------=•------------------------------------------------•------------------------------------------ ------------- ---------------------------------------------------------I---------------------------------------------------------- -----------------••---•--•---------------------------------------------------------- ---------- -------------------------------------- ---------------- -----------------•------------ ------------- -•-------- ------------------ ----------------------------------------------------------- --------------------------------------------------- --------------- -------------- -- ---- - • ------ .----------------------------- : ---------------------•-------•------- -----------...--------------------------------------------- f—' -Y FINAL INSPECTION BY-------------- Y.---l�!yOG(/ Date------------/[-_---^-------------------------- - "�" SAN JOAQUIN LOCAL HEALTH DISTRICT vuth American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street -kton, California Lodi, California Manteca, California Tracy, California 52 Revises! W-2140