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wrx� �,e Permit No�-_.�APPLICATION FOR SANITATION PERMIT(Complete in Duplicate) Dateplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. AND ----_- I ------ ----------------------- JOB ADDRESS - Phone---------=-------------------------- Owner's Name------------------- Address ------- ----------------------------------------------------------------------------------------------•----------------------------- Contractor's Name `` ----- ------ ----- Motel one Other .................• - Installation will serve: Residence 2 partment House ❑ ommercial ❑ Trailer Court ❑ ❑ ❑ Number of living units: ------ Number of bedrooms I------ Number of baths _------ Lot size ---_ X -- -- ---12�---------------------- Water Supply: Public system gj___Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e--Hardpan ❑ ` Previous Application Made: Yes ❑ No B New Construction: Yes 011415 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 20� feet Septic Tank: Distance from nearest wel��'t-C,_-Distan e from foundation___ _____________Matgrial__________________________._: _ No. of compartments_____ --------------Size-_�X._4- -------- -----Liquid depth--------= ----------------Capacity ----- --- r +� Distance from foundation.____________.Distance to nearest lot line!____________ Disposal Field: Distance from nearest wellNzwll _f _ Number of lines-__-_-----_ _ Length of each line-____A45-.f� Width of trench-------�. Type of filter material___ - -Depth of filter material__.___ _-__-__.-_Total length___________- y i�------ Seepa a Pit: Distance to nearest well__+r✓- --Distance f. oun�cRlation-_-_-0 e to nearest lot line_____ 1" (�[1�ize: Diameter I---------.Depth-- Number of pits-------1-------------Lining material_ 4 _ Cesspool: Distance from nearest well-----------------Distance from foundation__------------_-----Lining material-------------------------------------- Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------- Privy: Distance from nearest well_________ ___________________-----___---____.._Distance from nearest building-_-----------------__.______________._____. ------------------ ❑ Distance to nearest lot line--------------------- ---------------------------------------- Remodeling and/or repairing (describe):------------------ -------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta#e laws, and rules` nd regulations of the San Joaquin Local Health District. ' wnetirrdf or Contractor (Signed]_ ; #_ ------------ V_y ----- ---------- (Ti(Plot plan, showing size of lot, location stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY lo APPLICATION ACCEPTED BY------ --------------- --------------------------------------------- DATE REVIEWED BY------------------------------------------------ -----------------------------------------.- ----- ------------- - DATE ----- -------------------- BUILDINGPERMIT ISSUED------------------------------- ------------------------------------------------- DATE-------------------•---------------------------------------- Aiterat.ions and/or recommendations:-------------- ------------ - --------•----------------------------------------- - ----------------------- ------------------------------- -=----=------- -------------------------------------------------- ---------------- ------ - FINAL INSPECTION BY:-------- --"-------------------- Date �.- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT y' 5 .. 130 South American Street 300 West Oak Street 132 Sycamore Streef,„ 814 North "C,' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-5-2M 8-51 Revised W-2100