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APPLICATION F("1SANITATION PERMIT Permit No. Com `letein Duplicate) / +�Q { p p � �- Date Issued Applica4ion 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. 549.1 � ` ---- ------- JOB ADDRESS AND LOCATION--._______©--�_-- ---- -. Owner's Name--- :.: --------------------- ' --•----------•---------•-----------•-------------------------- ---- Address `Q F k Phone- :..r --- --"- ------------- --------------- - - - Contractor's Name----- 1-- -___-- - � I ' � Trailer Court Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ - ❑ , Number of living units: _--1-_-- Number of bedrooms _-3'_ Number of baths _-1-____ Lot�size ._-_-_._.4 '�___!-S-_fJ_---,__--_---_----__ ----- i I Private ❑ Depth to Water Table -------- ft. Water Supply: Public system EKCommunity system ❑ Adobe Hardpan Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay ❑Loam Clay El ❑ Previous Application Mode: Yes ❑ No New Construction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr.well-----------------Distance from foundation'ui-- depth__Material.----_--_Capacity--____- ._-.--_- No. of compartments---------- ---------------Size---- ------•----- q � Disposal Field: Distance from nearest well--------- ----Distance from foundation------------------.-Distance to-nearest lot line------_..---_--_ Number of lines----------------------------------Length of each line---------------------------- Width of trench ---Total length------------------------------- --------- Type of filter material-__---.-.---_.--__-____Depth of filter material----------------------- s �� , See a e Pit: Distance to nearest well_- Distance from foundation-----_________'-._-Distance to near " n - ----- Seepage - y p� Number of pits------I---------------Loring mate Si Diameter-----1.--------- DeP Cessool: Distance from nearest weal-}--------------Distance from foundation--------------------Lining material---.---_._--- _---------___---_-. l ❑ Size: Diameter-----------------------------------n-Depth----------------------- -------= Liquid Capacity gals- El Distance from nearest well---------------------------------------------------- Distance from nearest building--------------------------------------- ------- �• Distance'to nearest lot ine_____________ _______ O fir` ^ ' ----�'------- Remodeling 'r- \ Remodeling and/or repairing (describe):_---------------------------- ------- -----------------------------------------------------------•---•---------------•-- ---- ` I hereby certify thaf I have panda regulations a-olf the San Joaquin the work cal Heawill l Health done in accordance with San Joaquin County ordinances. State laws, and ru 9 1 - _. (Owner and/or Contractor) 1 ---•------------- {Signed}__.- -------------------------------- ----- 1 (Title)----,- ----------------------- fnrvs�a° By: .- --------------- ---------- - c ' [Plot plan, showing size of t, location of ystem in relation to wells, buildings, etc., can be placed on reverse side]. ( , FOR DEPARTMENT USE ONLY E ------------------ DATE ------------------------------------------ APPLICATION ACCEPTED BY----- ------------- —' lDATE _ BY -�... DATE----------------- ---------"-S BUILDING PERMIT ISSUED------------=------------ - ------ --------------------- ----------------------------- REVIEWED ! - _ ______________________________________ ___ ___________ Alterations and/or recommendat'ons--------------------- -�_ - ------.- ---------------------•- ---------------------- .w C ------------- r --- ------ - ------ ------------ ------------------ - --------- -------•----- --------•---------------------------------•---- Date- FINAL INSPECTION BY:.-- SAN JOAQUIN LOCAL HEALTH DISTRICT ¢ 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street y TrCalifornia Stookton, California Lodi, California Manteca, California Y' ES-4-2lA Revised W-1100 - `