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FOR OFFICE USE: --- -------------- -------------- --.� --- - ----. - APPLICATION FOR SANITATION PERMIT Permit ------- (Complete in Duplicate) Date Issued _ _ _ This Permit Expires 1 Year From Date Issued Application isrhereby�made to the San Joaquin Local Health District for a permit to construct and install the work herein described. My �, y,Or ha e o. 549. r w This application Is made m compliance with Count PP P JOB ADDRESS D LOC ION___ l - -------------------- --- _-- fC ---- ----- L Owner's Name - - ---- -•----•------------------- ---------------------------------- -------- Phon �A. _c1 ------ --------------- ------------------------------------- - --_ --- f=T �.- ------• -------------•-------------------•---------------- _ `.. Contractor's NAme------------------ ----------- Ape _______ __ • _'4° # Trailer Court Motel ❑ Other ❑ Installation will serve: Residence ApartmentiHouse ❑ Commercial .❑ ❑ Number of living units: _.j__-^Nu.mber of"bed `oms--V——N Tribe�6f'baths __�__--•Lot size __.S.___ •�-----------------•-------- WatertSupply: Public system ❑ Community system ❑ Private' DJ to Wafer.j.able,r_ -;�f#.� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑•- Sandy Loam ❑ Clay Loam ❑ Clay.❑ AclobeX:Hardpan ❑ Previous Application Made: (if yes,date _________---_ ___) No` New Construction: Yes El No FHA/VA: Yes ❑ No, TYPE OF INSTALLATION AND SPECIFICATIONS: _ -w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f t^ r Septic Tank: Distance from nearest well_4Q--------Distance from foundation__:._ _-__._.Material__ ' ---- Liquid---- 9 d 1• Z--------------Capacity . f r Disposal Fie.d: Distance from nearest weir _..._Distance from foundation-J-9 to nearest lotli�li e _�_Q_.°___ Number of lines----1p� C1---= ------Length of each line----- 1-t--------Width of trench ___ _�T______-.--------'--- / - . Type'of filter ma'terial_I..��_- a.KDepth of filter material____G__b_____________Total length_______ ,D_:_______________________ a Seepage Pit: Distance to nearest well-1/0 ---------Distance from oun tion__________...____ is ant to nearest lot line__ _ _. Linin material-_1_-----------tE�C ize: Diameter-_._.�. �---- --Depth-----.-5---------------i.-- '� Number of pits._(_-<- g + Cesspool: Distance from nearest well------------- ---Distance from foundation___________________ Lining material__-__.__________.______._______ __ ❑ Size: Diameter_______________________- .-----------Depth-------------------------------------- -------------Liquid Capacity------------------------------ 9aIs. Privy: Distance from nearest well_______________ ________________________________Distance from nearesf building__._-_ -------------------- --------- kNN� ❑ Distance to nearest lot line-------------- - ----- --- ---- ------ -------------------------------------------------------- -------- ------------ R deling and/or repairing (describe: ----------- --- ---- -- ZGL� --------------- - -------------------------------------------- -------- ---- ------------------------------------ ----------------------------------------------------------------------------------------------------------------- - ------- ------------------------ ------------------------------------------------------------------------------------ --------------------------------•-------------------------------------- - ! hereby certify th ave prepared t 's application an that the work will be done in accordance with San Joaquin County ordinances, State laws an rules and reg ions f the S oaquin Local Health District. f (Signed)_ -- - --- - --- --- ---------------------------------- (Owner and/or Contractor) - --- ----- -- - -- ---- - ----- --- ---t- ------ - --------------------- (Title)..... - ---- ---- - ---------------- (Plot plan, showing size o lot, location of system in rela on to wells, buil Ings, etc., can be plat on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ _ DATE_____.:- -'_6( ' REVIEWED BY------------------------------------ - - - -- ---------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED -------------- DATE---------------------------------------------------------- -- Alterations and/or recomm7endations:----------------- ---------- �-- - - --------- ------------------------•----•----•------------------------------------------•------------ -- i j ° k � --------------------------------------- ------------------------------------------ -G-6-------------I ---------------------------- F. ----------------- ------------------ ----------- --------------- --------I- --------------- -------- ----- FINAL INSPECTION BY;......... - Date----- 67. 1 G--------------- -------------------------------- - s OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.co.