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Y G Permit No. . - t �- APPLICATION FOR SANITATION PERMIT " (Complete in Duplicate) Date Issued �. San Joaquin Local Health District for a permit to constr t and install the work herein described. Application is hereby made to the q �s This application is made in compliance with County Ordinance No. 549. � � - l/ JOB ADDRESS AND LOCATION- ---- ` --- -- ----------- Phone__.7---._g-lr� Owner's Name----------- ----- ----- --•- --------- Address 7� .--G� . . --------•--- P o - --- ne---�O-/-t•ho e- r Contractor's Name---- 6 • Commercial�•j]�•Trailer•Court 0 —Motel ❑ ®» Apartment House ❑ Installation will serve: Residence/" la 1,?h'____. �-- Number of living units: -1----- Number of bedrooms __�-- Number of baths .l____ Lot size ________- E] Private ❑ Depth to Water Table y4-- ft. Water Supply: Public system Community system Clay Adobe ® Hardpan. ❑ Gravel Sandy Loam ❑ Clay Loam ❑ y ❑ Character of soil to a depth of 3 feet:,- Sand E]New Construction.- Yes No ❑ Previous Application Made: Yes Fl. No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r F Distance from nearest well-!%a 0 _- --Distance yfrom foundation___: - Mat�rial_._______._____--- QO - Septic Tank: / S , Liquid depth---y��- -- --------Capacity- -------- --- ----• No. of comparfiments_.---- ---- ---Size�ryQ--X / .094- x� Len th of each licie-------7 ---------------Width of trench.---�-y-��-- Width to nearest of me_________________ Disposal Field: Dis#ante from nearest wellNfl-.---. � Distance from foundation__________/' of lines S-- -- Total len th___.____.._ � Type of filter mafierial_ -. 4-E/'-----Depth of filter material------ ---------- Number g . 0 �e�� _•_.__:_.Distance to nearest loft line___------------ 11 �------ �, 6 a ----------- Seepage Pit:.. Distance to nearest well-----------------Distance from foundation.____ _. Deptn__.._... -_.___------- Size:,Diameter__---------------- Number of pits l-------------Lining material__- - - f- Distance from nearest well_______________Distance from foundation_____.______.___:-."Lining material_________-__-___-_._._-_____._-----. Cesspool: t I .- _ . -' Liquid Capacity---------------------- -----gals. ---De th-------------- a ` F-1 Size: Diameter ---------------- - p b Distance from nearest well---------------- Distance from nearest building------------- Privy: —' ---------------- ❑ Distance to nearest lot ins------------------- ----- ------ ------------- --------------------------------- Remodeling and/or repairing (describe):------------- ----- ------------ -------------...-•------------------.------------------•--- -------- y -: --------------------------------------------------------- ! hereby certif' that.•I have p edareduthi ns Ili the San Joaquin Local will b Districts accordance with San Joaquin County ordinances, State laws, and rules a g T- 1� ----------------------------------- ------------ (Signed) r and/or Contractor) (Owns (Signed)---- ---- ---- --------- " Title $Y: l� (Plot plan, showing size of lot, location4of system in relation to we11s,•buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY �� --------------------------- ------------;- DATE ', APPLICATION ACCEPTED BY-------------------------------------------4�,��,¢ --------------- DATE------------------- --'-------- ---------- BUILDING PERMIT ISSUED ------------------- ------ ----------- ---------------• Alterations and/or recommend ations:_---------------- -------- - -------•---------------•----•.----_--•- E ------ ----------------------------------------------- --------------- ---------------------------------- ------------------------------------------------ -------- Date-- ------- ---------------------- -------- -------- - ---------------------- FINAL INSPECTION BY:........ SAN JOAQUIN LOCAL HEALTH DISTRICT i32 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tray, California Stockton, California Lodi, California Manteca, California E5-9-2M 10-52 Revised W-2100