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FOR OEFICE USE: I ----------- -------- - - Permit No. - APPLICATION FOR SANITATION PERM ----------------------------------------- ------- (Complete in Duplicate} _ ____ ____________ ____ __ Date Issued ---------------------- „- This Permit Ex fres 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. 5 9. _ - -------------- -9 IFJOB ADDRESS AN N-----------� _47---------- Phone._. - f- Owner's NameQ----- �---------------------------- ------ 0Y � Address - ----- ' l i�✓,Sj------------------ Phone Contractor's Name l ,r ----- . /C�- r Motel Other Installation will serve: Residence [Apartment House El Commercial ❑ Trailer Court El ❑ff C] , rl Number;_of living units: __I__ Number of bedrooms __'Number of baths __ -____ Lot siz11 e I Water Supply: Public system` F1Community system E] Private ® Depth to Water Table- t+• • . Character of soil to a depth'of 3 feet: Sand [—] Gravel El Sandy Loam ❑ Clay Loam Clay E] Adobe E] Hardpan C] Previous Application Made:. (If yes,dote--------------------) No R New Construction: Yes E] No j& FHA/VA: Yes [INo R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or"cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from;neares�well_________ _____Distance from foundation---------------- _.Materiak-----------------------------------.--- -___-. ❑ No. of compartments-------------------------Size--------------------------- ---Liquid depthI--------------- --- CapacitY r Disposal Field: Distance fro0nearest well, Distance from foundation____J0__. I!_-_Distance to nearest lot � II N k Number of lines-------1------------ -----------Length of each ----------- Width of trench---p_- ---------------------- S • �/-t Depth of filter material_/,&-------_,_._Tota{ length...... '-0---------------------------- Type of filter matenal____--- .J P Seepage Pit: Distance to nearest wel!__��__-_-.___Distance fr foundation---ff�Q-_-___.Distance to nearest lot line--/.07/ , cf S Size: Diameter. Depth c ��---- ,Number of pits------ ____-.___-_-Lining material - .. Cesspool: Distance from nearest well_.______-______-Distance from foundation--------------- material -_----_-.------------------___--__-. ❑ Size: Diameter--------------------- ------ -- ----Depth------------------------- -------------------r:ll---Licluid Capacity----------------------------gals. t Privy: (�! Distance from nearest well---------------------------r-------------------Distance from nearest building--------_-------------------------------- III `.. ❑ Distance to nearest lot line------- -------- ---------------------------------------------------------,----------- 1 Remodeling and/or repairing (describe):--------- ----- � ---------- �"5 �� r ---------------------------------------------------------------__ ----------------------- ------------ ---------------------------------:�--------------------------------------------------------- ------------------------------I------------------------------------------------------------------- --- ---------------------- --------------------------------------------------- ---------------------- ---------------------------------------- - q , 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 lotions of the San Joaquin L al Disfric �� - �,, ner and r Contractor]. .. (Signed) -- ------------ ---- ' ' - - --- - �•��--------r---------------------------------------(Title]---------- ------ - --- ---f------ ------------------- bY ---------- (Plot plan, showing size of lot, locatio of system in relation to wells, buildings, etc., can b p placed on reverse side). FOR DEPARTMENT USE ONLY h ,/' DATE------ -------- -- -- 1 APPLICATION ACCEPTED BY------------------------------- REVIEWED BY- ------------•--- DATE----- --------------------------------------------------- --------------------- BUILDING PERMIT ISSUED---------- -- ------------ - -------------- DA-TE------------------------------------------------------------ 1U Alterations and/or recommendations:-.-. .... �9 _ �I ---------------------------- --- --------............. ---------------------------------------- ------------- t .a' !L r ----------------------------------------- ----- ----------------------------- - ---------------- --------- ---------------------------------- - -- i -------- ---------------------------------- ----------- ---------- ---- -------------------- • -- -- FINAL INSPECTION BY:,,- -. -------------------- � 0 Date = SAN JOAQUIN LOCAL HEALTH DISTRICT �. 1401 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street, 205 West 9th Street Stockton,California Lodi,California Manteca,California ' Tracy,California �I F.P.CC. J