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APPLICATION FOR SANITATION PERMIT Permit'No. (Complete in Duplicate) Date' Issued -�l--S----------- This ---This Permit Expire 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 herein described. ` This application is made in compliance with County Ordinance No. 544. k -------------------------------------------- JOB ADDRESS AN00_0__dy_'_o_c& CATION....I-=53-- - --- p' 1 r c .. ------. . ------------ Phone_ o .Q- Owner's Name------------- -----,zlJ �h5 - � � ,-- ------ Address----------------- �-- - - - } --`� 1IIGo?.`�/�_ E ------------------------------- Contractor's -------•--Contractor's Name----__-_ _ Motel Other ❑ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ O i -.- Number of baths -_1._ Lot size ------�1�-- ----• ----------------- Number ,. - -- ' Number of living units: __�-. Number of bedrooms _� �# Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel f-1SandyLoam El ay Loam ❑ Clay F] No obe I Hardpan ❑ Previous'Application Made: Yes ElNol�,New Construction: Ye€JNo ElFHA/VA: Yes ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' -0.--____..Material-__ ____�___------ " Capacity... Septi Tank: Distance from nearest w lII ._ � -Distance f r m foundation_-- - ------ - No. of compartments_.-/- - Size__---- Liquid depth___. - ---- � ! --- Disposal Field: Distance from,nearest well ---Distance from foundation_ Distance to nearest lot line_____ __________ Len th of each line__.__p-�- Width of trench-_24 24----------------•--- Number of lines----�---- ` g � # Total length--- '------------ T e of filter lines _.__ ;_ __Depth of filter mater:al____.� -_------- YP ' Q e �.=1.______.Distanc�eto nearest lot lir e__--•- See age Pi+: Distance to neares well_AAl` a------Distance from foundation--_-- �r 1.- --------------- See d 3-�- -----Depth----- .�+- Number of pits-_.__----------------Lining material__I�t1G. _.__...Size: Diameter__ U Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth_tiF•-------------------- -------- --------------Liquid Capacity gals. Privy: Distance from nearest well-------------------------- _.._Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------------------------------------- --------------------- ------------------------------- I } Remodeling and/or repairing describe):--------_-------------------------------------------•---------------------•----------------------------- -- ----------•------------------------------- C 4 l ------------------------------------------------ --------•------------• ----------------------•-- f -- ---------------------------------•----------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Ckvwa&.scmVm Contractor) (Signed) -- --------(Title)-- ------ - - -- ---- (plot plan, showing size of lot, location of system in relation to w s, buildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_�--------------- DATE------ _k ' ---------------------------------- ----------- DATE---------- - -•--�-------------------------•---------- REVIEWEDBY------------------------------------------------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------••---------- ---------------------------------------- - -- -- ---------------------- - - - --- --- Alteration an /or recommendations:___________ -------------------- .. I ... ---- ------- -- -- ---------- c�fc - - �� . ' rf' --------------------------------------- ION Y---- - -------------------- -------------------------------------- Date 4 l�v,J,D I SAN JOAQUIN LOCAL HEALTH DISTRICT TE' l32 5 camore Street 814 North "C" Street Tracy, California 0 l ^ 0 South Amer' an Street 300 West Oak Streot y , California Lodi, California Manteca, California // E5-9-2M Rcvised 8-'59 F.P.Co.