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Permit No. �.._7..d_-_--`-- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued __� �"`�•� - i Applica*ion is hereby made to 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 Ordina 49- JOB ADDRESS,AND LOCATION_... _Z_ -, o +-�•1`_"_/`l ----- Phone Owners Name._ �r Address----••----------•----------------------------- ; Contractor's Name------------------------------ �. t>L � �� = --- �a Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; l r Number of living units: _1 -_ Number of bedrooms � Number of baths ---_/___a of size ----I-D_"_________?4------l_.A-• -------- Water Supply: Public system ❑ Community system ❑ Privatej& Depth to Water Table A/-,0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe Hardpan El Previous Application Made: Yes ❑ .NoA New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 .._ _' ----- ------Material--------------- . - ------------•------•-------------- S T o ' , Distance from nearest welL____._.._______Distence from found ation__-__" No, of compartments--------------------------Size--------•------•----=------- ---Liquid depth--------------------------Capacity------------ -•--------/_ --• 16 Di osal F' ld: Distance from nearest well..-�"j-" _Distance from foundation__LO-_�-__-Distance to nearest loft line___'i ' ' �_-_-------Width of trench_._ -_`+ ................... .-_"_--------- � Number of lines--------I_________ -----_ "____Length of each line__> Q- jr �i r `�- 4L-6L Type of filter material-_-__..& .JS-Depth of filter material____-_/_�__._ ---Total length--c-50------------- __ tion-1 m. nearest lot line__f�-�-- 5eepa e Pit: Distance to nearest well �_________----Distance f m f undation- �� `� Size: Diameter-- -- ----Depth----------- ---- ----------- Number of pits-'4-----------------Lining material___- _- ---- 1--- - ` Distance from nearest well_________________Distance from foundation------------.---__--Lining material ------------ ------------- -------- y Cesspool: ----------------------------gels. r ❑ --------- --------- Size: Diameter-2 - -------De th------------------- - qCapacity l' ----------------- "-_-- Distance from nearest building --------- � Privy:° Distance from nearest well__"___-.__-______ _- " ----------------------- ---------- Remodeling and/or repairing (describe):__"-----------------"" -- - Distance to nearestlot line---------------------------------- ---------- -------- i , --------------------•----------•---------------------------------- -- -------------•-•--•------ --------------------------------------------_---------------------------------------------------------- ` i _ I hereby certify-+hat I ha a pr ared this application-and that the wor r will be done in accordance with San Joaquin County q Health District. ordinances, State laws, and a re ulatio s the an a urn Loc ---- ---- -----=- -------------------- (Signed) =( 'd� i<Contrctor) ---- -----------•--------- --- By:.... -----------•-------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, ildings, etc..An be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- DATE ----- ---�-�- --- ------------------- lREVIEWED BY------ ------------- --------- ---------------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------- -------------------------------------- -----• DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------- --------------------•--------------•---------------•---- = ---"------- ----•----------•-----------•-----�•"""-- ' r -------•-------- ---------------------------------------•--------------------------------------------------------- --------------------- --------------- ------ ---------- •-•-•--- ---------- - --•----=--------- Date---- -------- - - �--- �-�'-----��`--------------- FINAL INSPECTION BY---------------------------- ----------- ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT , 300 West Oak St�aet 132 Sycamore Street 814 North "C" Street 130`•South American Street Tracy, California Stockton, California Lodi, California Manfaea, California Es-9-2M\-�` Revised W-2100