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! R SANITATION PERMIT Permit No. "__"!._-22-�-- APPLICATION F4i (Complete in Duplicate) Date Issued Application is hereby made to the Sen'Joaquin Local Health District for a permit to construct an i st ll th work herein described. This application is made in compliance with County Ordinance No. 549. /9� Th pp --, F ---------------------- JOB, ------� -- 7�'g" z� JOB, ADDRESS AND LOCATION----D�-��F--�-6------;� -q"'""' , _ Phone "- ."__ (� �f Owner's Name- -- .T . .. ;.. - Address-------------------•---•------------- - - --------- - --. Phone-------------•--------------------- Contractor s ams-------------•----•---•----- ----•-------- ---- •-- Commercial Trailer Court ❑ Motel Other Installation will serve: Residence Apartment H\se ❑ ❑ �ns 12 ---------- Number of living units-. ..-- Number of bedrooms�-. Number of baths �lot'size _ ."_-.".- J.,__ Water Supply: Public system ❑ Community system,* Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamX. Clay Loam ❑...Clay ❑ :Adobe ❑ Hardpan ❑ Previous Application Made: Yes„ No ❑ New Construction: Yes No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: X (No septic tank orr is'available within 200 feet.) 'cesspool permitted if public sewe Septic Tank: Distance from nearest we}{ �-- -------- Distance from foundation"_./ --------Material--"""-_.__"__. __.___--`------------- � No.,of compartments------ �------- ---_Size__"'+�?�"�X:-'sem--------Liquid depth------4------------------------Capacity------- Disposal Field: Distance from nearest well_ r-_---_Distath of ce from each line_a�y a�.f-U__ .Wdth ofttre chest lot -----67--a-0f �----• 0 0 .5 O a Number of lines -------------------- - --------Len -a` , � g I - -----Total len th----------------•��- -L�--• Type of filter material" _ , Depth of filter material-""-._"_":/ 9 Seepage Pit: Distance to serest well__"._- "_"_-"" Distance from foundation-------------------Distance to nearest lot line_--_"_-"""-.___"_ I Number of pits Lining material Size: Diameter-----------------------Depth------------------------------ 1 Cesspool: Distance from nearest-well-" ,_------"_Distance from foundation--------'-----------Lining material-------------------------------------- �4 Liquid Capacity -gals. ❑ Size: Diameter----- -------- --- =--- ------- --Depth---------------------- - -------- -------- -- - t Distance from nearest building------------------------ Privy: Distance from nearest well------------- --------------- ------------------------------------- --- - ---------- ❑ Distance to nearest lot line------------------=---=----------- ------------------- --------------I ------------------------------ i Remodeling and/or repairing (describe) --------------------------------- --•-------------------------------- -- ----------- ----- -------------------------------------------------------------------- ------------------- 4a -- =--- - ----- I hereby ce tify that I have prep�ed this application and=that+he work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules re.gul�ons of the San Joaquin Local Health District. (Signed) R- -----=°------------- --------------------- -----------------------------(Owner and/or Contractor) - -- ---- --- Title By--------•---------•----• - ---------------------------- --- ----------------------- (Plot ------------------(Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY / r j - - DATE------------ DATE ---------- 1 J APPLICATION ACCEPTED BY__-__------==;:.-.- ' '' DATE----- ---------T�- ----- REVIEWED BY-------------------------------- - - ----------- -- -------------------------------------- DATE------------------------------------------------------- --- BUILDING PERMIT ISSUED ----------- ..-------------------------------------------------•--- --------------------------------------- Alterations and/or recommendations:_.____---"---------------- __"""""_. ---------------------------- - - ��-5-- -=-----------------------------_ Date"��--------- FINAL INSPECTION' BY:------- •------ --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street d` t Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M Revised 1•57 F.P.CO.