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APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) Date Issued �I ade to the San Joaquin Local Health District for a permit to construct and install the work herein described. pp ication is hereby m 0 � �y �This applicati i ma i .compliance with Cou ty Ordinance No. 549. Q µ .A f,- , OB ADDRES AND L CATIO __ ___ _ `� if- Owner s _ ---------•-- •---•------------••--------- Address------------- T -�--- - / - G� -- ---- Contractor's Name__-___. ____ ----- _, C C----------- --- Phone. 1 ' Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence 09-'Apartment House ❑ ❑ ! j Number of living units: 1-_ Number of bedrooms,- Number of baths -__ Lot size --•------------------------ Water Supply: Public system T-1Communitysystem Private [:1 Depth to Water Table (Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam El Clay Loam ❑ Clay E] Adobe" rdpan [I I Previous Application Made: Yes ❑ No FA"'-New Construction: Yes [/,��o ❑ FHA/VA: Yes [��ICro ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I : (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I - r -------- Material �• I I Septic Tank: Distance #rem nearer} wel4__��""_-Distance•,from foundation__��___.__ � 1 No. of compartments---tR-----------------Size �t 7 �� Liquid depth Capacity. r Q J1 s 1 I Distance from foundation___ -______-- Distance to nearest lot line___._.____. Disposal Field: Distance from neares well___ - __ - r/ en th of each line, _----- -- _ Width of trench---- -f------------------ I�f Number of lines------ ---------�--- ---- 9 �. s� f i Type of filter materiaL_l Depth of filter material__4P __._-__---Total length____---Z 7-------------------- a ______.Di `nce to nearest lot line__ ------- Seepage Pit: Distance to nearest well ___'r''__--_Distance frgm found tion___._ .ry . ®� - ¢e: Diameter_ -----Depth Number of pits------ -------------Lining material_ Q�r , ------------- --------Li Liquid Capacity gals Cesspool: Distance from neatest well-----------------Distance from foundation------------------ - Depth_---�'- -------------------- -----.Lin matperia Y---------'------------------ -'_._ ❑ Size: Qiameter-- == s Privy: Dis9ance from nearest we[L-.---------------- ------------------------Distance from nearest build:ng-----------------------------------------i 1 ❑ Distance to nearest lot line------------------ _•` 11 IRemodeling and/or repairing desc ' 4 •---------------------------------------- re):-------- _ --- ------------1------------=- -- ----- - ---------------------- --------------------------------------------------------------------------------------------------------------------------------------------- -- I hereby certify that I have prepared ibis.application and that the work will be done in accordance with San Joaquin County, ft I I � ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------------------------ Contractor) ?cation - ------- --------------------------------------------------{Title ----------- - By------------------ y [Plot plan, showing size of lotof system in.relation to wells, buildings, etc., can be placed on reverse de). FOR DEPARTMENT USE ONLY 1 i APPLICATION ACCEPTED BY-------- DATE----—------------------------------------------- REVIEWED BY---------------------------------------------------------- ------ ------------------•---------------------------------------- DATE------- I DATE--- ---- --- - 13UILDWG PERMIT ISSUED_. ----- - r^ ----------- Alterations and/or recommendations------------------------ -----------------"---- - 4 ---- --- - ---- f-.. ---------- --------------------------•---- - ,a. ---------------------------------------------- 1 FINAL INSPECTION BY:.___..._-____----...-- S _ Date-517-0----�-- --------------------------------------------- I I SAN JOAQUIN LOCAL HEALTH DISTRICT i y t 4 130 South American Street 300 Wast OStreet ' N 132 Sycamore Street 814 North "C" Street ak i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Raised 1-57 FY.CO_