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APPLICATION FOR SANITATION PERMIT Permit No. _ - Y (Complete in Duplicate) 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. 549. © / --- --- ----C1411e� -------AP4� ------ •---------------- JOB ADDRESS AND LOCATION____.____/_�___I__r .------------_ _ Owner's Name 6�_t`.1--1 fix .-4--�`- -- - .-------------,.. :-------- --------- Phone.-0 _.�=. - Address-----•-------------yf---�/------ - x -f-;-----�1�e��._l�n_��--.• -`--•---- ---��:---•�--•------------------------- •----•--------_�•-'lp---••-�----•--- v Contractor's Name = � ': -� _[7 ----�--- 1-�'-- x_ ._.__ Motel one C Ph Oth ❑ Installation will serve: Residence [R� Apartment House ❑ Commercial ❑ Trailer Court ❑ � ❑ _. Number of baths _f----- Lot size ___ _Q__-x--1 ��------- - Number of living units: ______`Number of bedrooms _ --------- �' Water Supply: Public system 0 Community system []_PrivateDepth'to WAt.;r-Table ft. Q Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑N 7 Previous Application Made: Yes E] No � New Construction: Yes ❑I No%� } TYPE'OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.)r Septic Tank: Distance from nearest weII__ ___-_;Distance from foundation__ ____________r.Material _______ __-___.__. ________________.__ No. of compartments:--_--- -_---- --------Size_-_-- �p__��-�-�� Liquid de th-=----- -�--------- --- - --Capacify.�d0-�---- p _- ----,____(Distance from foundation__ ____..._.`Distance to nearest lot lime___ _--------- Disposal ________ Number of lines^___. *---7 Len th of each line____ -- idth of trench.__- -_ Dis osal Field: Distance from nearest we ._ YP . t T e oT filter materi,l-A" __--_ g -'- -- otal length_-- ----------------------------- FI -- - �CvCI., Depth of filter material___ / to nearest well_:_.__±_____----------Distance from foundation -___-___.Dista'ce to nearest lot line________._ Seerpaage Pit: Distance y lC1 j / Number of its -- L g i!U --- Deptn _ Linin matersal___��_____ "._Size: Diameter___._ - , Cesspool: Distance from nearest well-----------------Distance from foundation__________________ Lining material------------------------------------- ❑ Size: Diameter. = = -=Depth w = --=�5---_.:__`Liqusd Capacity _ 9als, t E .,______________________ Distance from nearest .building------------------------------------- Privy: Distance from nearest well_ - ❑ Distance to nearest,lot`line_______---- _ .. —.,., - - ---- ----- i -- �: = ------- -u----- ---------------------------- -- Remodeling and/or repairing (descii�e�---- -- -- ---------- -� / � •------_------- -- _ - • ------------------------------------------------------------:--------- .. - - = ------ ------------ --------_= = E ___________________ j ________________________.______________________________--_____-__ ___--._______--____._____•--____.._______. ____--_____-i___________________________ ___ _________________________________________________________ I hereby certify tha I have prepared t is-application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, nd rules and regItions of the San Joaquin Local Health District. 1 f " / {• �f-------------1------- (Owner 9d/or Contractor) (Signed) ----------- ! - -- ----- ..............-------- ---------- By:--_-------------- ;" ------_- (Plot plan, showing size of lot, location of system in relatiodfo wells, buildings, etc., can be pllac d on reverse side). FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY.-_ ----------------------- -' --------------------- DATE_ ------------------------ REVIEWED BY------------------------------- ---------------------------------------- DATE `�� BUILDINGPERMIT ISSUED-----------------------•---- - ---------------------------------------------- Alterations and/or recommendations------------------------------- -------------- ° ---•------•--------------------•---,---••- •• --------------- -------------------------------- - --------------------------------- ------------------------ --------------------- ------ ----------------- - ------------- NSA Z�y Date-------0 r, ---- - ------------- FINAL INSPECTION BY---------------------------------------- - - - ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Sfreet Stockton, California Lodi, Californie Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100