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APPLICATION FOR SANITATION PERMIT Permit No.-.�l-��•-••--• (Complete in Duplicate) Date Issued __JI��-• This'Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin. Local Health District for a permit to construe/}and '-stall the work herein described. k - a licatiori is made in complian e with County Ordi ante No. 549. SC pP - -This ,,. _ -- -------1�-- JOB ADDRESS N LOCATION_ _ +�/� _ Phone_.. --------- . ------------ ------- Owner's Name---- --� u� _�--•------••q�--•--Z•-- C'� -t�}J f -------------------- =------------- 1`---•-----•---•------------------------------------------•----•--------•-----•-•- • Address -1: 1._._._.�J�� ------- Phone _---------------------- --•----•"- t r Contractor's Name_____________ � �---------------------- I Motel ❑ Other ❑ Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court C1 --- Number of baths _-_(--- Lot size ---- ----- -- - Number of living units: ______'Number of bedrooms ; �4 Water 5u I Publics stem Community system ❑ Private ❑ Depth to � Water Table .4- ft. pp y• y ® Hardpan Gravel Sand loam ❑ Clay Loam ❑ Clay ❑ Adobe ® ❑ Character of soil to a depth of 3 feet: Sand.❑_ _❑_ Y VA: Yes ❑ No Q Previous Application Made: Yes ❑, No E] New Construction: Yes [� No ❑ FHA/ j SPECIFICATIONS: I TYPE OFINSTAL Isepfic tank Oo or AND Dool ermitted if blit sewer is available within 20Of eet.] 4 a P p (�' , ------------ ,` Septic Tank: h I Distance from nearest well_ _ -Distance from foundation_-____ _ __"__._ _ Ca act " r No. of compartments Size. ' K X-- -----Liquid depth P y I Y , "$ Distance from foundatyo ___:Q -f --------Distance to nearest lot line________________ Dispasal' Field: i Distance from nearest wjeV ten th of each line__"__+ Width of trench.___"`a.rf---Number of lines_____________ g-= ;�_De th of filter material_- -___�_ -----Total lengt ___._-" _Type of filter material__ I?„•,_2-m i r_ .-.�- rr� •.�,~ ` Distance to nearest well __________--------- Distance from foundsiie:-Diameter__"-Dis#ante topeP+hst of line ---- Seepage Pi}:�_. 1 ti i = _ Linin material---------------"- --. ❑� Number of pits- "- -- --- - - g 9. Cesspool: " "= Distance from nearest well_________________Distance from foundation- linin materia gals. Depth - --Liquid Capacity-- ❑ - `_,,;. Size: Diameter--------------------------- -------- P • � -Distance from nearest building_" Privy- Vit. Distance from nearest well -___------------------------ - _.. ,•a-°•-•-:..❑ � ^� Distance to nearest lot line ------------------------------------------------ ---------------------------------- --- ---------------- •-------•,----------•----------------•------------------------ • --------------- Remode4ing and/or repairing (descri e):____----------------- - ------------------------------ .--.- - --------------------------- ---� --------------- ----------- --------------------------•------------------- v and that ------------------------------------ ------------------------------------------------------------ --------------------- --on -- -----•------- - - -------- ----- ---- -- --- - wor I hereby certify that I have paeppareduthi this oli the San Joaquin LocalkHealltheDistrictn accordance with San Joaquin County ordinances. State laws, and rules R 9 ----------=---'---------------- -- �nerand�or �Contor] Si necl° /�'/ ,Q -•----- ------------- - - -- ( 9 Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I ' - DATE -------------------�"--•------- �-'c" . APPLICATION ACCEPTED BY.-ry._..-------- DATE ---------------- REVIEWED BY -------------------------------- DATE BUILDINGPERMIT ISSUED -------------------------- -------------------------"-•-------•------•------------------------------------------- Alterations and/or recommendations ----------------------- __._--___--___-------.----. ----•-------•--------- ---- -------------------------- "--•---------------------�-------- ----------------------------------------- 1.Date-------- --- - j _ - "{'--------------------------------------------- FINAL INSPECTION :.--------- - - - --------------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT l32 Sycamore Street 814 North "C Street 30D West Oak Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E5 -9-2M Revised 13-'59 F.P.Co. --