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APPLICATION FOR SANITATION PERMIT Permit No. 5.- '_ (Complete in Duplicate) Date Issued Application is hereby made to the SanJoaquinLocal Health District for a permit to construct and install the work h This application is made in compliance,with County Ordinance No. erein described. ATION- .j�d-_-q7 e --- s �� " A.:----------- ------ JOB ADDRESS AND LO Owner's Name----- -------------- Ph Address-.. Q.;i t._ on .- -. •-•------- Contractor's Name- -- ------------------- --- ---- "� �-- ---------•---•--....----•-- Installation will serve: Residence x Ph a �partmerit,House ❑ Commercial'❑ -Trailer ❑Court Motei Other-❑ Number of livingunits: _- .- t, ,, �--- Number of bedrooms _-iZ. Number of baths - � Lot size ----7157= kll Water Supply: Publics stem � � --••------_••------•-----._ y (�Commu6ity system ❑ Private:❑ Depth to-Water Table -14 ff Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑, Previous Application Made Yes ❑ No n' New Construction: Yes 9�`No ❑ FHA/VA: Yes [A�o ❑ TYPE OF INSTALLATION-,AND SPECIFICATIONS: (No septic tank or'esspool permitted if public sewer is available within 200-feet.) Septic Tank: Distance from nearest well---'"�- � '~ ' - � '" � -_-_--Distance -from foundation_--�P__--___.Material-^_ - ----- No, of compar#ments----- ►_______________Size-e ! -- -- ' - �-�----_� urd dap#h----: -- --� __ Ca acit __ �` Disposal Fieid: Distance from nearest weli-------. Distance orrf u bion P Y Numbec' of lines_______ ______ --------Distance to nearest lot line SO— _- ----------_-_-_ Len th of each line--- type of filter material-/-'1--,og " -- Width of trench_-_---�rf--- _ -_ -. -Depth of filter material--_ pp-If �4-------- ---Total length------xf'p P g to nearest well._-----tw- _---'_Distance fpm fou ation-_-__ L > _.Drstance to nearest )of ee� Number of pi#s--_--/-------------Lining material `' f E -Sze: Diame#er-. --------------Depth--------�''------ �+ Cesspool: -----_ �� ❑P Distance from nearest well__________ _____ Distance from"foundation-----__------_-----Lining material--------_.--__._--_- �� _� � Size: Diameter------------_--- -- �l ;7 Depth - - Liquid Capacity----------------------------gals. ❑ Distance' Priv " y , • ,from nearest well.-------------------�------- -----------------Distance from nearest building_---_------------ - ' Distance ante to nearest lot ' line---- = — .� _ LM, _ drepairing -- ------ ------------------ ---- ' Remodeling an reP .r.mg (describe):----- --------------------------------------- _-_ - - i- ----------- -- ---------------------- '- i` — --•-----I-•------------ ------ (`` I ! hereby certify that I h ---- ----•---- -----------------------------=------------------------------------------•-- �N\ Y Y have prepared this application and that the work will be done in accordance with San Joaquin--------------- Coun+y ordinances, State laws, and rules an regulations of the San Joa ' Local Health District. (Signed)- - �. : ! �oe By-------------------- ntractr Co or) { p g Y g (TitlePlot lan, showin size of lot cation of s stem in relation to wells buildin s, etc., can be pcs ode), r . i= FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED B ,Y----- � ------- - -- ---- --------- -------- -------- -------`--------------------------------------------------- DATE----- REVIEWED BY-------------- " ( = - BUILDING PERMIT ISSUED- - =+ �' DATE. \7 DATE--------L------------- -- Altera#ions and/or recommendations:____ _.._- - '� l� ------------------------------------------- ------------------------------------ ------- -------------------------------- ---- --------- E '- ��"f ` ---------------------- - ------------- - ----------------- - ----------------------------------- .-FINAL INSPECTION B -- - -------------------------- - Date-- "�-- --k ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree4r i 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, CaPornie814 North "C" Street Manteca, California Tracy, California ES-4-2M Revised 1.57 F.P.CO. I - 1