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' APPLICATION FOR SANITATION PER MIT Permit No�f•C (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District fora ` er Da}e`Issued ; This application is made in cori pfiance with County Ordinance No. q• p mit to construct and instal! the work herein described- JOB ADDRESS AND LOCATION_---- ._ ' Owners Name_____________ ---•- _. Q Address----------`--•-----• -- --------------------- - ---"-- Phone.----------•-- Contractor's Name_ ------------------------------------ --------------•----------•----------------------•- ------- ----•---------- /�_ -'- � ' 4irfc"_� Phon _ Installanion will serve: Residence Apartment House E3 Commer ial ------------- , � . Numb ❑ Trailer Court ❑ Motel I er of Irving units: _�___-_ um er o edrooms - umber of baths _ Lot size •-/ ❑" Other ❑] •:,Wafer'kSupply- Public's stern � -_____._.-__ •• Y ❑� Community system ❑ Private� D ✓ epth to Water Table �ffi. Character of soil to a depth;"'r. 3 feet: Sand [I Gravel ❑ Sandy Loam E] Cla" Loam Previous Application Made: Yes No Y ❑ Clay E] Adobe 11 Hardpan ❑ - I ❑ New Construction: Yes [j No ,FHA%VA: Yes ❑ . No TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepiic Tank or'cesspool permitted if public sewer is available within 200 feet) ;;� eptic T kr Distance:from nearest well_________________Distance from'foundation______^___- No, of compartments_._- -------------- ---Size----•---•---- - -------.Material-------------- �_.. ------ I. •----------------Liquid depth Capacity________ __ s oral eld: Distance from nearest well _`-_--°,Distance from found ,. Number of lines_________tl ,� -------"Distance to nearest lot line. ' ----- ------Length of each line_ i '�_ Width of trench_aType of filter materia f _Depth of filter materia_-_. ___ Total length-__-__---'- ,epa e t: Distance to neares w __._ .___Distan from foundation _�'-___Distance to nearest lot.iine___- -; -� Number of pits-_ -------- -----Lining material ` :!l Size Diameter- ,�}!�� - --Depths „' Cess"oof: ..., --------- ----- - _____________Distance"from foundation----_--_---_:'_-_--_ Lining,material--------------------------------------- Privy: ____-----_---____ ------------ Distance from nearest well-___ ❑ Size: Diameter---- - - "- ---------------------Depth------- ----- --- ----- -- ---- I .+�:� ---------------------Liquid-Capacity -= gals. �. Privy: Distance ffom nearest well----------------------------- #" ------._Distance from neares+ building,---- >-_ ❑ Distance to nearest lot""line_ _--_--__--_: --------------- 7- I ____ '________________________ repairing describe emodeling and/or re g }= -----• --- - .T... ' , ----- -----------------------'--------- ---- - ------------ --------------------------------- -------- ------ --------- -- :�i" - -r_'�---------------------------------------------------- e ----------•-----------•------•---•-----------•---- --•------------------------•-----------•--•------•-_--------------•- ---------_--'- ------------------------------------------ ordinances.' --------••------ ---:..---+- I here rtify than ! have p spared fhis application and chat nhe work will--e "one in accordance with San Joaquin County ordinances,'State aws, and rul s nd1reg at' ns " rn ocal Health District. , (Signed) h -- -- --------------- `•- - (Title)(Plot plan, showing size of lot, location of system in 5 P Y o wells, build' s etc., can be laced on reverse side). + DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-'..____. __-__--_ - ----------------------------------------------------------------I-------------------------- REVIEWED BY --------------------"I---------- ----D----A------T---- ATE UfLDING PERMIT ISSUED-------..1 DATE teranions and/or recommendations:-------- - -------- ---------- ----- ------------ DATE----------------- ---------- -----•- --------- ----------------- ---------------- ----- y -------------------- , . p,r„� =`=- ' er ----------- ----------------------- - *z.. -- ------------------- I; -------------------------------------- = --- ------•----------s-Fi:,::�------ FINAL INSPECTION B _ {� - �_-- ----- GGr ((00 �------'-'- Date-- --=�--------- � ___ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street :1 30Q West Oak Street Stockton, California :, 132 Sycamore Street 814 North "C” Street Lodi, California Manteca, California Tracy, California ES-9-2M Reviseci 1-57 F,P.CO.