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FOR OFFI E U E. ti -- . Permit No. ..--------•---•--•- ••- 3- APPLICATION FOR SANITATION PERMIT -- -- -- (Complete in Duplicate) Z 2 _ 1 p I °- Date Issued ._..--.-- R ---•• - This Permit Expires 1 Year From Date Issued A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. PP This application is made in compliance with County Ordinance No. 549. r --•------------ �� . JOB ADDRESS AND LOCATI N -._ - --- -- -- ------------- -...... ...- Owner's ame-------- -..- ----- Address.----- - -- -- ------ ------- -------- Contractor' -•-- Phone. Contractor's Name----------- --- ------ ------- •- - - - Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ . ap Number of living units: _f---- Number of bedrooms .2- Number,of baths _-_-.__ Lot size ./- Water Supply: Public system [ �-ommunity system ❑ Private ❑ Depth to Water Table 70 t• o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam d' Clay Loam ❑ Clay ❑ Adobe - Hardpan ❑ Character of soil t p }tA/VA: Yes ❑ No Previous Application Made: (If yes,date----------- -----) No ®' New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200'f eet.) Se tic,�Tank� _ Distance from nearest well-----------------Distance from foundation_ :-_-__.--..---. i --------------- Material T No. of compartments-------------- ---•------Size---------------•---------------Liquid depth----------------- Capacity.. f --•--- Disposal Field: Distance from nearest well.----.--—--_Distance from foundation..- - Width oft}re Chesil°� line___ ___-__..._ Number of lines__---,------------__------- Length of each line-_-- Q----1 •4 Type of filter materiae Depth of filter material---,t ___--__--_Total length------- _40-- •-•--- ��.-._-Distance f m fou --------Distance to nearest lot line r'?(/----.----_ Q Seepage Pit: Distance to nearest well---___.--____ �` Depth_ ----/-•------------ p - _-----_-L'snin material-�Q- _._ -- _.Size: Diameter ---_---- ---- f" Number of pits----_/--- g _______ Cesspool: Distance from nearest well-------._--_-.--Distance from foundation------------- - --"Liquid Capacity gals. Size: Diameter---- ----------------- ---------------Depth---------------------------------------------------- Privy: ---•---------------- ---------------------------- q P Y ( , ❑ --------.-Distance from nearest building---------------------------------------- Distance Distance from nearest well--------------•---------- - ------ --- ---__------_- ❑ Distance to nearest lot line-------------------------- ------- ----- -- -------------------If - Remodeling and/or repairing (describe)--------------- -- - - --------------- ---------•------------------------------ ------------------------- --------•------------------------------- - ------------------------------------------------ •- •-------------- ---------- ---•-----•-----•------------------------•------------ ----•---•-----------------------------•- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rul and regulations of the San Joaquin Local Health District. -..(Owner and/or Contractorl - ----------- -- - -- (Signed) ------------------- - ------ - �— ------(Title}---- - - -- �------ ---- -- -- ----- -- - ------------------------- (plot plan, showing site of lot, location of s in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------------ DATE `-'- z'- ' ' �� k------ ----------------- APPLICATION ACCEPTED BY---- Qs�----------------------- --------- ------ DATE-------------------------------------------------------- REVIEWED BY----- ----------------------------------- ---�------ ------------ ---- -----------------------------------------•-------------- DATE.------------------ ATE.- ---------...--------- -------- -•----------------------•- BUILDINGPERMIT ISSUED-------------------------------------------- -------------------------------------------- ---------------------------------- --------- Alterations and/or recommendations:----------------------------- - - ---•------.-.-----•-----------••------_-•- FINAL INSPECTION BY:--- ----- ----------------- Date ............ - SAN JOAQUIN LOCAL HEALTH DISTRICT # 205 west 9th street 300 West Oak Street 124 Sycamore Street 130 South American Street Manteca,California Slocktonr California Tracy,California Lodi,California ES_9 REV19E0 8-69 r.P.co.2M 6.6P