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�y r APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) O Date Issued , l A plica ion is hereby made to the San Joaquin Local Health District for a permit to construct an__s ��e vv rk here' ► This li nlirafis he b ma p ^i an- �.i.+h County OrdinancL 549, des ed. c'--0 1 J08 AgDRESS AND LOCATION,__--- ,, CZ � � Owner's Name------------ ----- - '�-`-� -- ---- -------------------- -A ----------- ' ` _�w. . -�CEG >... _ ' Address-------- --- ------ --------------------- Phone------------- --------=--=------•--'- r� `c1L _ ". Contractor's Name----------- --------•- -----------•--------- ------- - ------------------------------------------------------------------------------------------ ---------- Ph - -- --- Installation will serve: Residence Apartment !-louse ❑ Commercial [] one._•3_g- _'�5-�- ..,._.O „,�__�� ,_ .�-. Trailer, Court--❑*�-Motei Number of living units: __ Number of bedrooms -,3- ❑ Other°❑ -"" - Number of baths _�____ Lot size Wafer Supply: Public system ❑ Community system"[] s-" ------------ o Wafer '/041 Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loa Clay tCla Loam _ � {t• i Previous Application Made: 'Yes y ❑ Clay ❑ Adobe❑ Hardpan ❑ _ ❑ No J�'. New Coristructiori: Yes No [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well __-_-Distance from foundation____D�,' _ �` X_ No. of compartments___ -_-_" ze_ --.Material--------------------------------- ---"-_--Liquid depth-------- ._O -.__Ca-.---Capacity �cvO Dispose .Field: Distance from nearest wefi..,,_.?P-_----.Distance from foundetion____/Q i p y ; ___-..Distance to nearest lot line._____ Number of fines___.___�_�---------------------Length of each7ine~__ ' -__.Width of trench_.__-_____Z �( Type of filter material__._ ph �� .- -Depth of filter material_.---------j�_-----Total length-------- ----------- Nu ______ _._ Seepage Pit: Distance'to'nea'rest`wel!----------------------Distance from foundation_____ ❑ Number of pits-------=----- ---r--Lining material-----------------`-_ --Distance to nea'est'lot'line----------------- !� ize. Diameter---------------------.Depth Cesspool: Distance from nearest well----------------- W Distance from foundation ____- - -. L - Size:-Diameter- in�ng maternal._. . Depf'h _.---- Liquid ' ��; g - - -- Liquid Capacity-- ---•--- rivy:, Distance from nearest v✓eIL -------- els. ---------------------___-Distance from nearest buildin ❑ �� .Distance to nearest lot�iine:- --- -- ------- ----------------------------------------------------- g- ------ -----------•------- ------- -� - ------------ Remodeling and/or repairing (describe):--------- ---------- I ' ---------------- ----------"------------------------------------------•------------------------- ------------------------------------ Iher --------------------------------------- l hereby certify }ha I have'p�epared this application and,that the work will be done in accordance with San Joaquin County. ordinances, State la and rules and regulations of the Sa Joaquin Lacal Health District. (Signed)------------ - - - -------------------- --------------------- O 8y:---_ --------------------------------------------I , when and/or Contracforj - - - ----s- -------- -- -- -------------(Title)-------------------------•-- (Plo+:plan, sowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side-- I ` FOR DEPARTMENT USE ONLY w RAPPLI EVIEWED ATION-ACCEPTEb BY = _ ---- ------------------------------------------- ` DATE_----' REVIEWED BY �(`}� _ : ---------. DATE.------ WLDlNG .PERMIT ISSUED-_______-- --__-- ------ ---"""- - ' -- ---------------------------=-------- °- ------ ------ DATE_..----------------------- terations and/or recommendations:_______. ----------------------------------- --------------------------------------- •------ -•------ ---------------- --- ------------------------------------------------------------------------------- - --------•-------------------- - - --------- ---- FINAL INSPECTION BY------------------ --------------------------- ate---=---- -. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 3 o L Stockton, California 132 Sycamore Street 914 North "C" Street d Lodi, California Manteca, California Tracy, California E$-4-2M ; Revised W-2100 - r