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APPLICATION FOR SANITATION PERMITj c r (Complete ' ` Permit No. C •._.z _ � � � P m Duplicate) _� _ Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to r: ct and in This application is made in compliance with County Ordin nce No. 9. stall the work herein described. J08 ADDRESS AND LO TION_.,! - < tJ f Owner's Name-- _ ----------------------------------- Address ��J`7 --- �[ -------------------- - - Phone• ----------------------------------------------------------- --------------------------------------- Contractor's Name---------__-" " Installation will serve: Residence 'Apartment - ---------•---- ---------------- "-- - ------ Phone------ ---------- - House - - ----- -----•---- ---------� " ❑ Commercial ---------• ------ � Number of living units:'-/-_-_ Number of bedrooms __-_--" ❑ Trailer Court ❑ Motel ❑ Other ❑ Water Supply: PublicSys tem Number of baths ,1�----- Lot size _�r_ _ [ Community system ❑ Private' "� --` -- _ Character of soil to a•depth of 3 feet: Sand � Depth to Water Table "__-".". ft. Previous Application Made; Yes [� No �ew avel [f� Sandy Loam ❑ Clay Loam ❑ Cla Construction: Yes Y ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATipN$; • NO ❑ FH 4/V 4; Yes ❑ No [j (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) + Di : san ,c Se tTank: p tance from nearest well-"- -----Distance from foundation ``"�Q No. of compartments" _.Material_-_ .___ ,G� ------Size_ Liquid - X �� Liquid depth- f''C� Disposa Field: Distance from nearest weU" -"Distance from foundation - ------Capacity.--Rd, j:; - Number of.lines-- _--- "------------ Distance to nearest lot line.--- 0 Length of each line-_----" Type of filter material- ��" Width of trench-"-- r DEpth of-.filter material -- Seepage Pit: Distance to nearest welt " ----Total len th_-_-""__ ___f_j_� _ ------_Distance from foundation__-.- g ❑ Number of pits--------------- ---.___-__.Distance to nearest lot line-"-"-__-__ " .r e Lining material_ Size: Diameter --------Depth------------------•-- �. Cesspool; Distance fi'om nearest well =—� --_-_Distance from .foundation--------------------Lining material"----"-_-_______" � Size: Diameter-------------------------------------- ------------------------Depth------------------------------------, -- ---"-" Privy: Distance from nearest well--"__--_____"-_"_ Liquid Capaci tY----------- ----- -----•---gals. Distance-to nearest lot line"-_ ------------------------------Distance from nearest building _ "_-"-- " -------------------------------�I Remodeling and/or repairing (describe):. ____ •-------------•-----•--------•----- --------- ------------ --- f ------------ ------"--•------•---•-----------"-----------•----------------------'".""-_"_""-"----- -----------------------------•--•---------------- --"----- _ - 4 - - ----------------------•-----"-----------'---------------•--------------------------------------------•---------•----•---•--------"---------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Co ordinances, State laws, `and rules and regulations of the San Joaquin Local Health District. Gr(• _" - (Signed]_ 4 unty --------------------------------------------------------------- - By:----------------------•----•------•----------- --- (Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __--"- """" REVIEWED BY- -------------------------------------------- DATE---- ------ - -- BUILDING PERMIT ISSUED" ------ - -- L 1 DATE '.' -- ----- -----`' - ---------------------------- --------------------------- D /or recommendstions:-.------•4 e� -- ----- ATE - Alterations a� �"-- - = = _"::_ r ----- -----------------------`il--------------------------- l� ---------------------------------- - - -- -------- ------------------------ ------------ ----------------------------- - FINAL INSPECTION BY:----_ - --------------------- Date--- 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street Sfockfan, California Lodi, California 8i4 Tracy. "C" nia Manteca. California Trec , E5-9-21x1 , Revised Y California l•57 i=,P,CO. J