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7FORFICE USE: '" ,� permit No.APPLICATION FOR SANITATION PERMIT .(Complete in Duplicate) —Date #slued('�L/ This Permit Ex fres 1 Year From Date Issued ------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereindescribed. This application is made in compliance with County Ordinance No. 549. ----=----- ----------- -- ----------- ------------------------=------------------------ JOB ADDRESS AND LOCATIO _._.___ ° Phone------------------- ----- --------------------------------------------------------- ------------------ ----------------------------- Owner's Name---- � ' `yz� -------------------------------- - -- ---------------- Address---- .......... r---- Phone_ 'r ---- - ----------- Motel ❑ Other Contractor's Name________________ "- - - Commercial ❑ Trailer Court ❑ Apartment House ❑ S �('.---------------------- Number will serve: Residence --- Lot size -_� / ". Number of baths .� Number of living units: -f----- Number of bedrooms - Depth to Water Tablex.-o- ft. Community system ❑ Private ❑ P Adobe[Hardpan ❑ Water Supply: Public system [ ❑ Clay Gravel ❑ Sandy Loam ❑ Clay Loam Y❑/FHA/VA: Yes ❑ No ❑ Character of soil to a depth of 3 feet: Sand ❑ l No New Construction: Yes ❑ No L` , Previous Application Made: (if yes,date__-.____---_----- TYPE OF INSTALLATION AND SPECIFICATIONS: in Material------------------------------------------------ Distance septic tank or cesspool permitted if public sewer stanceafromefouhda?oo feet.) Capacity------------------_--- 4p ______________________ ptic Tank: Distance from nearest well----------------- -_-Liquid depth--------------------------- --- Size .:_.----- - a ---- No. of compartments_._ ,� - -y� Distance from foundation._.�:U�--."__.Distance to nearest lot ine_. - Distance from nearest well._s/_11N-'�-- p ---_��---.Width of trench--___. � �-" '" Disposal Fie Q Number of lines.__.__. � Length of each line...... J Total lengthy Q . [� Type of filter material_-��-f�a4-/----Depth of filter material_.__..h ---� �V dation D ____.Distan Distance to nearest lot line. d Distance to nearest well.-Distance 3_ . Depth Distance ------ V Seepage Pit: _Linin materi __-._ Size: Diameter_._ ❑/ Number of pits._._- -------- g foundation__-_-------------Lining material___.._""------------------------"-` tion----------------- Liquid Capacity--------------------------•gals. Cesspool: Distance from nearest well-----------------Dista ❑ Size: Diameter"_-_-_____"__----------- Dept -----------------------------Distance from nearest building------------------- Privy: Distance from nearest well-----------------_-------------- -------- ---------------------- ------------------------ ❑ Distance to nearest lot line.- ---------------------------------------------------------•-•------ - -------------•---•--•----- Remodeling and/or repairing (describe):----------------------------- ----------------•------------------------ --------------- -------------------------------•----------------------------------------------"------------•------- ---•- - .-.________-------------"-•-------- --- lication and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this app e law ,,and rules and gulations of the n Joaquin �ocal Health District. or Contractor) ordinances, S (Owner and/ ---- ----- $i ned - By:----------------------------------------- p (Plot plan. showing size of lot, location of system in relation +o wells, bui Ings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY �. DATE------- 6 ----- --------------------------------------- ------ ---- - ......7---------- APPLICATION ACCEPTED BY.._._... ----------- ----- DATE------------------------------------------------------------ DATE ;---------- ---------------------- REVIEWED BY - - --------- - ------------------------ BUILDING PERMIT ISSUE0.__________________._._____ --------------- - j= = or recommendations:---------t ------ -------------------------------- Alterations and/ ---•--- ------------------------------------------------- ------------------------------------------- ---------------------------------------------------------I-------------------- Date.. ------------------ ---------------------------------------------------------------- Date-- �1... •_ 7 ------------------- FINAL INSPECTION BY--------------- --"--�""-"" � UIN LOCAL HEALTH DISTRICT SAN JOAQ 205 west 9th Street 124 Sycamore Street California 300 West Oak Street Tracy, 1601 E.Hazelton Ave. Lodi,California Manteca,California Stockton,California F.P.co.