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g • Permit No. ---• - --- --•-- ' " APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued __- . Y� av herein described. ealth District for a permit to construct and install the work is hereby made to the San Joaquin Local H {tion is made in compliance with County Ord Hance No. 549. ��----------------- /� �-----�---- - --------------- "-�- � - ---"- Phone------------------ TRESS AND LOCA`TIC�N _-� -- -f -------------•- ------------------ Vame- ' ----------------- Phone----------------------------------- -� ----- - Other ❑ ----- M tel ❑ }or's Name--- --- - Trailer Court M? tel Commercial ❑ .J ----=---------- A Apartment House ❑ Q---AJ -.--- ---- tion will serve: Residence p , _ ____ Number of baths __._-"_ Lot size --- --- - _ ! $ ft. Number of living units: -_1----" umber of bedrooms Private ❑ Depth to Water Table Hardpan ❑ Public system system ❑ i Clay Loam �laY ❑ Adobe❑ it Supply: Pu Y ' ❑ Gravel ❑ Sandy Loam ,fatter of soil to a depth of 3 feet: San New Construction: Yes L1"-�/No ❑ fev Application Made: Yes ❑ No�u�{ ' PE OF INSTALLATION AND SPECIFICATIONS serer available within 284 feet / ion_ - Mater lj (No septic tank or cesspool perm#ted if frooun I - _- sta t---------- - Capacity" --- � Distance from .nearest well Liqu+d op. Septic ank: Ize - °f compartments -"-"-- - Q�stance to nearest lot l' e�- ----" No, istance from foundation- " _ ,,�y � Width °f trench-- .-- Distance from nearest w -Length of each line------- lI -- W Dispas I Field: � - .Total length_"_---- -� - Number of lines----------- -- Type of filter matsf _�___ Depth of filter material""-_.-i✓- � --- --- _Defence from foundation--------------------Distance to nearest lot line----------------- filter Pit:` Distance to nearest well--------------- ----Size: Diameter-------------- --------.Depth------------------------------- Pit` ------------------------.--" Lining material---------- ---------------------- . Number of pits---- }- - _gals, M ❑ -------- th------------------------------ ------�- ---- --------------- ---- --- --� �--- --Liquid Capacity- --------------- Distance from nearest 'Well_-_."-------- --Distance from foundation----------- --- ---Lining material-_"------- Cesspool. - ❑ Size: Diameter._"-"----------------------------------- ---- --•-- --� �--- "-' --'-- ep ------- --- ------- --pistance from nearest building---------------------------------------- Privy: - ----------- Distance from nearest we ".------ -----------�"- - Privy: -- ---- --------- ❑ .pistance to nearest lot liner -------- - ------------------------------------•-•--------•-------- � RemodB4ing and/or repairing (descnbe):---- ------•----------------------------------------fi. - ----------------------------- ---------------------- -------------------------------------•-- - - - ------------------------------------------------------------- c --- - ---------- ---"------" hcation and that the work will be done in accordance with San Joaquin County ----------- a------ a re�ared this app uin Local Health District.! hereby certify that } have p p -(Owner and/or Contractor) ordinances, Sta a laws, and rules and regulations of the San Soaq •------- - - - -- -------- - --- -------------------- ------------------------------- ------ (Signed)-- - l ----------------- ` (Title) ]. can be laced on reverse side ____ __ ----------------- -------- p i _ _______________ y- buildings, etc., 8y. sise of lot, location of system in relation to wells, (plot plan, showing ' FOR DEPARTMENT USE ONLY DATE ---------------- ----------------------------- r- DATE_-. � ---------------------- APPLICATION ACCEPTED B DATE----- - -- REVIEWED By--------------------------------- - BUILDING PERMIT ISSIiED �,, �1,��:_r - "� or recommendations:--------------------;:-- ----------- -------- ------- ------------------ - Alter tions and/ �...... a. to- = Y -. - ----- --------------------------- - ---------------------- -----• -- -- . --- ----- i r ------------------------- f -�- Date --.-----"----------- ----•-- ---- F - ----------- F1NAL INSPECTION BY:-._- " `---- SAN SOAQUIN LOCAL HEALTH DISTRICT $14 North "C" street 132 sycamore Street Tracy, California 130 South American Street 300 West Oak Street Manteca, California Lodi, California . Stockton. California W-2100 — —