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`aQ' �--•( APPLICATION FOR SANITATION PERMIT Permit No. __ ._ - (Complete in Duplicate) Date Issued -- Applica{ion is hereby made �o 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 ordinance No. 5 9 :$ ------------------- JOB ADDRESS AND LO ATION---__--.. --- --L - ---------------- _ Owner's Name ------------------ ----------- - _ Phone---� ��j�-�--------- <� Address_ ---- -- ------ •------------------•----------•-----••---- ---••------------------ -! f------------------------------------------- -- - Contractor's Name Phone-- . :,�! • d ` Installation will server Resi�enceK Apartment Nouse [I Co ❑ Trailer Court E] Motel E] Other Number of living units:Is: r - Number of bedrooms _ Number of baths Lot size --- p �Q Water Su I Publics stem Community•system ❑ Private ❑ Depth to Water Table Jaz ft. Supply: y ❑ y Adobe Hardpan Character of soil to a dept of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ P ❑ H Previous Application Made.-;Yes ❑ No New Construction: Yes No E] Z. TYPE{OF INSTALLATION 11 AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I� Septic ank: Distance from nearest well _-..-.-------Distance from foundation----- MatenaL___________________________________________ No. of compartments---- -- Size---••----------------- --------- Liquid deptly Capacity IM: isposal el Qistanci from nearest well------___________Distance from faunclationDistance to nearest of ane._______.____..._ Number of lines_ Length of each line--------•---------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material------------ --------- length_._.____-_.__.____.____._________:.�_.._ _.____Distance f m f ndation_.jf' ._--.Distance to nearest lot ' Seepage Pit: Distanc� to nearest well: �" Dept -Size: Diameter--�----------�--- - �n-------------- -------- --�� Number of pits-------------------Lining materia�,� - !`� .11, Cesspool: Distance from nearest well--------------- Distance from foundatio ---- Lining mapacit_..--..-_--____----___.___.__. - --------------------••---------------- q Capacity _ - Liquid Ca acit Sizer Diameter-- -------- ------- --- ---_--Depth ❑ 91! t _-pistance from nearest building---------------------------------- Privy: ----------------------- ❑ Distance to nearest lot line--...__.--_ -------•--------------- ----------- -- -• - • - - --- ---- Remodeling an or repairing (describe):__. - \ " - - - - =------------ - - - - ------------ !' - ----------------------------------------------------------------------------------- ! hereby certify that�l have pre d this ap 'cation and that the work will be done in accordance with San Joaquin County Health District. ordinances, State I .d rules d the San Joaquin Local A ------ --- ----•-------- :---- ---(Owner and/or Contractor) ----- - ------------- (Signed) - --- ---------- - --1 --- ------------------------------- ------•------- (Titl ---------------------------- BY---------• -------•-------- -- ----•-- ------ buildings, etc., can be piked o reverse side). (Plot plan, showing size of lot, location o system in relation to wells, FOR DEPARTMENT USE ONLY DATE_._--------- �"*'t-- - ------ APPLICATION ACCEPTED BY DATE-------------- a�`---------------••-------- REVIEWED BY------------------1i=----------------- --------•---------------- DATE BUILDINGPERMIT ISSUED------------------------------- ---- -- ------- -•- ---- --------------•---------•--- Alterations and/or recommendations:---------- ---------------- - _.._. ----- ----•---- --•------ -- -------- ------------ ---------------------------------------- FINAL INSPECTION BY:. ---------- --------------------------- Date-----..�-------------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT ° 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tracy, California Lodi, California Manteca, California y' Stockton, Celiforni 6`1111 Es-J^7M 145446 ATWC-D 1 12-5a