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Permit No. -•--- -----•-- •-- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ereb 'made to the San Joaquin Local Health District for a permit to construct and install ework herein described. ( Application is h y This application is made in compliance with County Ordinance Nog. 4QS'- '37 - ---- JOB ADDRESS AND LOCATION_-- --------------•.------_ --- --------------- ----- d Owners Name---45A .� •------------------ ----•-- r n--.. --------- --- ----- - Address----------- _ '; - (.� ,_ � - --------------------------•-"---=------ Phone-------------------•- - --------- Contractor's Name--,,,- ------------------------- _L-------- Hous Other Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court [ Ar el ❑� Number of living units: __f_____ Number of bedrooms _� -- Number-of baths ----- Lot size,--_----------------------- - Water Supply: Public system ❑ CommL"pity system ❑ Pr'svate ® Depth to Water Table PP Adobe Hardpan Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ Previous Application Made: Ye NoX. New Construction:- YesX No F1F.HA/VA: Yes ❑ No ❑ ti. TYPE OF INSTALLATION AND/SPECIFICATIONS: (No septic.tank or`cesspool permitted if'public sewer is available within 200 feet.) ii W, - Material------------------------------ - --------- ---------- - i Septic Tank: Distance from near{est well__d��_-___-.--10 Distangc+ o foundation uid depth _.___�----------------Capacity_-t �---� No. of comPP .partmerits___�-- f Size__ q Disposal Field: Distance frorn nearest/ell_ _ - Distance from foundation---------Wthcofttrench nearest Zl f line-------- f ----=--------- Number of ii ----- Length of each line__---i------ .._ I Type of filter tA material---_4_3e -Depth of filter material__,__-_-- '-_------Total length_______----------------------------------- Type ________ __ _ ____ . - s �+ _L__..Distzince to nearest lot line----�'----- Seepage.Pit: Distance to nearest well 4-0-----------f--Distance from foundation___.__. "' Linin material- _ _ Size: Diameter---_. I ---- ----.Depth__, �--------- S 1 - Number of pits-----f_____--- g ------ __ --- Ce�spool: Distance fi-om nearest well ----=------Distance from foundation--__------__-:-____.Lining material___.._-_.._____----- els. De th------------------- Size: - - - ---- Liquid Capacity -g ❑ Diameter------------------------ -Depth .,p ---------------- ------- ---Distance from nearest building------------------------------------ Privy- ---- ------------------------------Privy: Distance from nearest well._ = --------------------- Distance to nearest of ine_-_-_-------------------------------------------------- - - ----- ---•------------------- t --------- -------•--------•--- ------•----------------------•------- descnbe} ----------•------- ------- ---- Remodeling and/or repairing ( i ` -- ---_----------•-•- ---------- ----- ----------- ! -- ---- -- -- ---------'---- -----------'-------------------------------------------- ---------- t ----------------------------------------------- -------- .._ ------------------------ ----------------------------------------- 1 .; i -------------------------=------------•-------------------:-:--,. _ I hereby certify that.1 have prepare ibis is a Ili the San Jothat the aquin work HealtheDistric}n accordance with San Joaquin County ordinances, State laws, an rules g ---------- -----(Owner and/or Contractor) s--; '-------�- - (Signed) = -- * By:--------------- X• ° (Title]. Plot Ian, showing size of lot, location`of system - ion ----- buildings, - c. em in relation to wells; etc., can be placed on reverse side). ( 1_01 FOR DEPARTMENT USE ONLY DATE---- �. n � ------------------------------ APPLICATION ACCEPTED BY -„ -------------------------------------------------------- DATE--------------- REVIEWED BY-------------------------------- ----------------- - . ----- ------ DATE------�-- ---------•----------------- �-----.._..'------- •- BUIL ING Alterations ons and olr.recommDendations---t---------------------- -- -----------___----- ------- ------------------- " •-------• ----- --------------------- -.---_ .___. !_. -, _______ _______________ '� -------------------------------- , . ___ ________________________ ' _-__-_-_____ __.---_.-. Date - FINAL INSPECTION BY k� SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "G" Street ~ti l30 South American Street 300 West Oak Street Tracy, California Lodi, California Manteca, California Stockton, California j yM Revised 1-57 VP.CQ.