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Permit No. ------•--•-----•------•-` 4 .APPLICATION FOR SANITATION PERMIT ,J (Complete in Duplicate) Date Issued Joaquin Local Health District for a permit to construct and install the work herein 7—ml Application is hereby made t . orithe San q This application is made in compliance with County Ordinance �o. 549• � � . t 1 JOB ADDRESS AND L CAT N_____ Phon Owner's Name_ ---- --- --- r - ----------------- -------- - _._� --- ----- ----------•----- Address----------- -- � � -- Phone------------------------- Contractor's ------------ ------ ------------------------------- Motel Other ❑ Contractor s Name----------------,_. ------•-------- - Trailer Court ❑ �. Installation will serve: Residence: rtment House .❑ Cofnmercial ❑ I�, __ Lot size ._ Y-_ -"__ Number of baths ___ - �-•• I Number of living units: __ ._--- Number of bedrooms _ t Supply*. public'system ❑ Community system ❑ Private Depth to Water -C�lay � YAdobe Hardpan ❑ Water pp Y Gravel ❑ Sandy Loam ❑ Clay ❑ Character of soil to a depth'lof 3 feet: Sand ❑ No ❑ FHA/VA: Yes ❑ No : Previous Application Made: Yes ❑ NoDal New Construction: Yes +� t TYPE OF INSTALLATION AND SPECIFICATIONS: ^ ' septic tank or cesspool permitted if public sewer is available within 200 feet.) k' -— ' (No p . MatQria4 -------- - ------ (� Distance from nearest well_-.4�--Distance from foundatio ___._ " - � a acit - ' Septic Tank: �- _-- __Liquid depth--_"-_-- ------ P Y =Size---- No. of compartments-____. Distance to nearest lot line---le-142 F _ Distance from foundation -- 1 Distance from nearest,well._ -.- Width of trench.-____ -!� Dis os l Field: �. Len th of each line__"____ '� � P • _ _To#al length..----�--.=-a- - ----------------- Nu e of of Imes--_"_"-- --- �£p}h of filter mater al___-----)--5-- Type off Iter material__ -- --- - " "--pistance from foundation____________________Distance to nearest lot line_______________.. Seepage Pit: Distance to nearest we4l------------------ Size: Diameter----------------- -Depth-------------------------------- Seepage --- --- : ❑ Number of pits----------=--- -Lining material:----------•-- ------- gals.N- Cesspool: Dista) from nearest well_________________Distance from founda}ion-.-----------------.Lining material pacit-------------------------------------- I -------------------- Cesspool: _- ----- --- "" _ _ Liquid Ca aci �. - - Dept ------- - -- - -- -- - - 5ize: Diameter- - ------------------------------------- Distance❑ . � - T " '" from nearest building p Distante from nearest well -- - - - --- ---. ---------------------------------------- Privy, -------------- I ----------------------------------- -scribe) --- --------- --- - ------ -, ❑ Distance to nearest lot line-_-__--"--=-----: - G� - ---- • ---- ---- Remodeling a d/or repairing (describe :-----. /_r.. ' - /t = 2 " I C �. - ..----- �r. = �G r I hereby certify that'�.I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul and reg of the San Joaquin Local Health District. (Owner an Contractor) I 1 ---------------------•--- --- ----------------------------- (Signad)_ � ,.. ---- -------- --(Title)--------------------------------------------------'------------- -- -------------------------------------------------------------- --------------------- --- Y� . buildings,'etc., can be placed on reverse si e . (Plot plan, showing size o' lot, location of system in.relation to we s,x p "FOR DEPARTMENT USE ONLY - -------- ----,-�---•---�------------- DATE_-----•----------------------------------- ---�-- APPLICATION ACCEP' D BY------------------------------ ------------- � DATE-- - e1 ------ ----- s?' -- - REVIEWED BY - '--------------------------- ------- - ----- DATE_------------ ---- ��o"" BUILDING PERMIT ISSUED ------- ---------------------- Alterations and/or reco1.mmendations----------------------------------- ---""-"--"•---""""" "--- __---"- -------------------•----- -------•----------------------------------•---------- t ------------------- -- --• ---------- ,.. -- : ------- -- : --- ---------- I - __ _ - ----------- -- i - ------------------ IDate.--- -------------------------- ------ -- --- - - FINAL INSPECTION ,BY---------------- v SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street Street 132 Sycamore Street California 300 West Oak Street Manteca, California Tracy, . 130 South American 4 Lodi, California Stockton, California ES-9-2M Revisesrt 1-57 f.P.CO.