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APPLICATION FOR SANITATION PERMIT Permit J . _.'_�-•�-�.. -- ' ` (Complete in Duplicate) I`I Date Issued .-/-�-?:Ij��- ' e to.the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby mad q I This application is made in compliance with County Ordinance No. 54- JOB ADDRESS AND LOCATION...: ,q�------may- ---d_. -------------------------- q` 4 Phone----II"------------------------------ Owner s Name.--_.___ - ---- - --- - Address C = - on -- -------------------------- ---- ---� / 1GContractor's Nama - • Commercial Trailer Court ❑ Motel ❑ Other E]Installation will serve: Residence[Apartment House El ❑ „- ------------------- . Number of bedrooms _ - Number of baths ._f__ Lot size 1�-X--- = Number of living units: _,l_ Water Supply: Public system [— Community system ❑ Private ❑„Depth to Water Table _ ft. o AdoHardpan ❑ Character of soil to a depth of 3 feet:i Sand El . Gravel ❑. SanZ.dy Loam ❑ Clay Loam ❑ Clay ❑ ,I Previous Application Made: Yes ❑ No Pr" New Construction: Yes [1, No [ FHA/VA: Yes [!�'No El TYPE OF INSTALLATION AND SPECIFICATIONS: ` < (No septic tank or'cesspool permitted if public sewer is available within"200 feet.) ` w # ., , I - - .M -. - Matorial....G-t-4- - / / / Septic Tank: Distance #rom nearest.well__F-_I�D- _-Distance/farm foundation_.__ _ � � - ---- i `/Z+ Size__+ -.e O- ---Liquid depth � Ca pacitY No. of compartments--- - ----------------- - �•p ` _ /1x ---------Dist to nearest lot line___._______. Disposal Field: Distance from neares well_ .:_.Distance from foundation Number of lines-----:------ -- ------- ------ ength of each line' -+ - =-----=------Width of french--- /---_----- 1 fDe Depth of filter material---- /f"----- -Total length----_e1-r f�---- -------------------- i Type of filter matenal__/_ .__ _ p # Distance f om foun atlon_--� ----.D'st nce to nearest lot-line___Ze-_-._- Seepage Pit: Distance to nearest welL_ � ----- H k - ¢e: Diameter--- - - --- Dept4iM� ' s 4 L� Number of pii-s-------'r----•-------Lining mafer:al��- �-- - .. ------ Cesspool: Distance from nearest well----------------rDistance from foundation--------------------Lining mat erial_.�I� : ' .___ -----:- ^' Size: Diameter-------'----------------------------=---Death-----_------`------------ ------ Liquid Capacity_i�yll�l. gals. l Distance from nearest - ______°{_-- ------.--------Distance from nearest building------- �--:___---_---__.-_-_.---__.---. Privy: ❑ _ Eat Distance to nearest lot line- '---------- ------=' l=` -- ----------------- Remodeling and/or repairing (descrlbe)______________�___ __._ 1 �M' ' ------- --------------------------------------------------------------------:-_.__--_•-_-___----F-----------_------__--_-______.____._____________._________._________.____ -___.____._____._ .__i___ - ____� _______.._____.____.____._ s___-----__-__---__•__-_--____•_-..-__-.__---__.-_--. _______ ___ _________ __ ___ _ __-_ _ .----_-___-_---__--_--_ ---____---------_-._---_..__.______________________._._ _ I hereby certify that I have prepared this application and'that the work will be done in accordance with San Joaquin Co ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Contractor h = ( gr C o Si - ' ( gned] ..:�_ - ------------------(Title]_`.�.�- size of to cation of system in.relation to wells, buildings, etc., can be placed on raver side]. (Plot plan, showings E f s FOR DEPARTMENT USE ONLY. :If I �� DATE-_. - --I ---- --------------------- APPLICATION ACCEPTED BY---- --------- ------- "--- ----- --- -=-----------; ------------•--------------------DATE �- -- -- ----------------------------------- REVIEWED BY--------------- - , BUILDING PERMIT JSSUED__:. ------------ - ---------------------------------- -- _Alterations and/or recommendatio -- --- --- ------- -- -- l __.. - ---- -- - s.� ` ---- -- -- ---------- -- --------------------Il`------------------------------- --- ----------- ----------- - -- -------------------------------------------------------- --------.- - . ----------------------'------"-- ------------r'--------------- ,. -_ k -----------------------------{ - FINAL INSPECTION BY.------_, Date3 SAN JOAQUIN LOCAL HEALTH DISTRICT t 132 Sycamore Street 914 North "C" Street 130 South American Street 300 West Oak Street: V" 4 R * y .,1. l1odi,,Caliiornie � ' ' Manteca, California Tracy, California Stockton, California I E5-9-2MRevisea 1.57 F.P.CO.