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APPLICATION FOR SANITATION PERMIT Permit No:"• J---�--••� (Complete in Duplicate) Date Issued ___ l.�z_l_��3"-• w This Permit Expires 1 Year From Date Issued Application is hereby made to the Sari 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."49. v_.. - z - " ~ _ JOB ADDRESS AND LOCATION sr ------------------------------- L" '� = -------- Address ---------------- ----------- Owner's ------- Pon r Owners Name h---------- : ... „a Address__ •/ �� _..�;•--- �-tl:�^__r---_=---•--------��--.---------�•-------•------•------------------•---------•------- --- - _ one •------•------ Contractor's Name--- ----------- -- , """ Motel Other ❑ Installation will server Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ �! ❑ G Number of living units: ________ Number of bedrooms Z._._ Number of baths -------- Lot size .___-____ -------� Private Depth to Water Table ________ ft. Water Supply: Public system Q Community system ❑ ,❑_.__ „ _ Adobe Hardpan ❑ J" tr•. Character of soil to a`depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam_❑ Clay Loam ❑ Clay ❑ 50 Previous Application Made: Yes ❑ No New Construction,:Yes' ] No Q � FHA/VA: Yes F] No TYPE OF INSTALLATION "AND SPECIFICATIONS: (No septic tank or cesspoolpermit+ed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___.S _G--E-Distance from foundation Material____-___ ________.___-. .______--______."---- s. `' .--------.-Capacity r� `� No'10 i . of coin artments-------------------- Size_- _x_---=---X---•5------Liqusd depth---------- --- ` p _ Disposal Field: Distance from nearest well �747___e_Distance from foundation___._1 _____.Distance to nearest lot line-_--j---_------ �. Numbbr of lines----------J-------------------M-Length of each line-----------r ------_ Width of tre4ch.---__--01- -- y _De th of filter material-------�-E---------Total length_:--------�Q-.---•-------------------- -f ---•-------•- Type of filter material_-__�!r�-/�----l M P _ _..r�-•. .. 1 Seepage Pst: Distance to nearest well____J_____---- Distance from foundation__l�' __-____.Distance t-- Weare-- I� l 1G Number of pits-----I------- Lining' material--_-- --gin- "'Size: Diameter_ Deptn__1 ' .�` __ Cesspool: Distance from nearest well_________________ Distance from foundation._.._______'___.---.Ltn�ng materia""-.----.-.---- els. Li uid Ca aci g 4 -i---- = q A t tY ❑ Size: Diameter------------------------- Depth_ Distance from nearest building ------------------------ Privy: Distance from nearest well------------------- I ! ----------------------- ' ❑ Distance to nearest lot line----- -- ------- ---------------- ------ --- ------------------------------------------------------------------- - ------------------------ Remodeling and/or repairing (descri e)--------------------- --------------------------------- ---------------- ---------------------- ' r.:«:�:, __ ---------------------------------------------------------------------------------- -.=_w-f { i ----------------------------------------------------------------------------- I hereby certify3Aat I have prepared this application and that the work will be done in accordance with San Joaquin oun y i ordinances, State laws, and rules and reg o+s f the San Joaquin Local Health District. i (Owner,and/ Contrecfior ----------- (Signed) U Title ( ) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY------------------------ ----- - DATE-- - DATE------ /- - REVIEWEDBY-------------------------------- ----------------- --- ---- ------------------•--- -- --- '� ,_---------------••---------•-------- ------------------ --------------------- i' BUILDING PERMIT ISSUED-----------=------ -------------- ----- -----------,._------•--__=--•---__`::�__=�-_-=_---------- ----------- ------=------------- ------- -------^ ------------ - r------ .-.--....---.--�"r-- Alterat,ons and/or recommendations:-- -_--�:_::.:"�;..:�-- e -------------------------------•---------------••-----•-----------------.. -- ------ ------ ---- -------------------- �, _f ----------------------------- ---- ------- �� .i -= -- --------- Date ---------------- ------------------------- FINAL INSPECTION :------------- -------------------------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M Revised 8-'59 F.P.Co.