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APPLICATION FOR SANITATION PERMIT Permit No, __ 'iM icate(Complete lbate Issued ' S Application is hereby made to the San Joaquin th CountcaOrdinance tfNoc 549r a permit to construct and install the work herein described. This application is made in compliance Y D ----- JOB ADDRESS AND LOCATION_- ry -------- hone Owner's Name 11 IIS ---------------------------- ---- ------ ----------- - ---•------------ •------•-----.---- Address. - one ------------------------- Address.- Contractor's - --------------- Con#ractor's Name______. --- -- --, - p �,� Commercial Trailer Court ❑ Motel ❑ Other Installation will serve: Residence L�" artment House ❑ ❑ size IA� ------- Nurnber of living units: --/-- Number of bedrooms __ Number of bfhhto to°Table t•of Water Supply: Public system Community system ❑ Private E] Dep Gravel .Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y No FHA/VA: Yes ❑ No � previous Application Made: Yes E]I No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if.public sewer is available within 200 feet.) l __ __ pet' dank; Distance from nearest well----------------- from foundation Liquid de th -Material--------- Capacity_______ _______________ i No. of compartments---------=--------------- Size q p. Dis sal Field: Distance from nearest well..... ------Distance from foundation___--__ __-`----.Distance to neares �#Jl��------------_-- 1� Number of lines-----i/------- ------ ------- Length of each line___. _ -----fir--- Width of #ranch--------" i' Type of filter ma -Depth of filter material_:__ _,__'____Total length_____ __--------- p Seepage Pit: Distance to nearest well____-_' __----_Dis#ante f o foun anon__________________ ' anc to nearest �Ijjt li e__ _____-i__-__ i Size: Diamete� -/�-- -.Depth_ x- A, Number of pits.`-_/------------- Lining material.��_�! 1`r R q Cesspool: Distance.from nearest well_____--______--_Distance from foundation____________ ______Lining material - Li uid Ca otic _ gall s. 171 Size: Diameter--------------------------•-------------Depth- ----------------------------- 9 p Y Distance from nearest building------------------------------- -------- - ' Privy: Distance from nearest well----------- --------- ------------------------ El ------_------- `z❑ Distance to nearest lot line.___________-- -------------------------------------------------- �� ,�' Remodeling and/or repairing (dei gibe):__-- ------------------------------------------- --------- I --------------------------------------------------------------------------------- 3 � ion and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this applicat ordinances, State laws, and rules €nd regul ions of the San Joaquin Local Health District. PP s --------- erten ontract --- {Own /or. C or) Si ned "(T tl -------------- r�, i -- ------ ---' -- i sy:. y {Plot plan, showing size of lot, lot of s stem in relation to wells, buildings, etc., can be placed on rde). FOR DEPARTMENT USE ONLY DATE- - -�----- --'--- ----"=------- ,----------------------------------------- - APPLICATION ACCEPTED BY-_- DATE -•------.- - REVIEWEDBY------------------------------ - ------------------------------------- DATE------.- - ------------- - ----------- ---------------- BUILDING PERMIT ISSUED---- and/or recommendations.------ ---- - _--_----_---__------ ,-------------- ------------------------------------------------ ----------------- - - -- --------------------- ------------- >-------------------- FINAL INSPECTION" BY:.---e--- -----"----------------------------------------- SAN ----- -:----- - SAN JOAQUiN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street ff 300 West Oak Street Tracy, California • f Manteca, California Y' Stockton, California Lodi, California I f i.- ES-4-2M Revised 1.57 F.P.CO• ,.