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APPLICATION FOR SANITATION PERMIT Permit No. ---- -- - -- 'i (Complete in Duplicate) Date Issued ']'fJ11 f Applica{ion is hereby made to:the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in cdmpliance with Cobnty Ordinance No. S49. -- ----•--- JOB ADDRESS AND OC TION_.. n Phone-------------------------------•---- Owner s Name---------- Address - ------ -- -- ---- --------- Phone.-----------•---------------=------ Contractor's Name---- -----G�c/L-- Installation will serve: Residence Apartment House F1 Commercial E] Trailer Court [IMotel ❑ Other El Number of bedrooms .-- - Number of baths Lot size .____"_ Jd� x f ------------ Number of living units; - - Private Depth to Water-Table � ft. Water Supply: Public system RCommunity system ❑ ❑ p j ' Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam El Clay [jAdobe�Hardpan ❑ Previous Application Made: Yes E] 1.No�_New Construction: Yes JZ[—No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Distance,'from nearest welV............... Distance from #oundation____._______.___---.Material____________._____:_-------._____.._-�._________.- of compar#mems - ----Size-------- ------- -------- --Liquid depth--------------------------Capacity F Disposa"F'j,'eId: ,- nte,from nearest well_._--__.___...--Distance from foundation--------------------Distance to nearest lot.line__..___________.: ber,,of lines------------------- - ------------Length of each line-----------------------:--- -.Width of trench------------------------------------- 7— T e of.`filter material----------..__.___------Depth of filter material------------------ ----Total length______________________ -----� it �j �— " ,,f ;stance from four ation___ C�.-.-•-.Distanceo nearest lot line-- -- -- i Seepage Pit: Distance to nearest well___/-{G-1�?"'---- ; --Size: Diameter_ Deptn___. ------------- .!of -------- O Number of pits____..-:-= - --_Lining material____- Distance from foundation --------Lining material-------------------------------------- Liqui Ca acit -___gals Cess❑ool: ea Di rneter nearest well ---- ----------Depth------------------------------------------- -- q P y----------------- Siz ------------------------- ---------Distance from nearest buildingiY Privy: Qistanc'e from nearest well- --------- Distance to nearest lot lire------------------------- ----- ----- --------- -----•----- i Remodeling and/or repairing (describe)------------------------------------------ ------ F • - ------"---------------------------------I-------- l ----•----- ------------------------------- --- d I hereby certify t I'have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, Stat ws d rules,and regulations of the San Joaquin Local Health District. ------- (o er and/or Contractor (Signe - �ftl� ------------74 - --- --- --- --------- ---------- --(PIo# plan, s owing slot, ocation of system in relation to wells, buildings, etc., can be placed on reverse si , FOR DEPARTMENT USE ONLY APPLICATION D BY = ------------------------------------ DATE---- -------------------------------------------- , DATE----- ------;/------------------------------------------ REVIEWED -----------REV EWED BY ACCEPT ------------ ---------- `------------ ---------- ------- ---------------"----------------------. DATE----------- - ---------------------------------------•- BUILDING PERMIT ISSUED.------------------------ - :; • Al#erations and/or recommendations:_._._ ... -- - --------- - -------------------------- --------------------- ----------------------- --- -- - ------ �-a-----=----- . .� -------------------------. Date_ -- -.- - ------------------------------------- FINAL INSPECTION BY:"----------- ---------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street" 132 Sycamore Street 014 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y, ES-9-2M 146446 ATWOOP 12.54 -