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L , APPLICATION FOR SANITATION PERMIT Com lete in Duplicate) Date issued the Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to This application is made in compliance with County Ordinance No. 549. ov/ �� 5 JOB ADDRESS ACD LOCATION ....5_0 ---JJ---r------------------------------------------------------------------ __ Phone----------------------------------- 7 5 �_ .l 5----- ---------- Owner s Name ' / ----------------- Address-------- •-------------------•--------------------------�`L��'{�!/ Phone ---- - - - --- Contractor's Name______________---------•- Frailer Court ❑ Motel ❑ Other A artment House ❑ Commercial ❑ ' Installation will serve: Residence p _______ _________ f � -- Number of living units: _t_-"- Number of bedrooms _.____._ Number f baths .__ of s¢e��-- -----f. stem Community system ❑ Private Depth to Water Tab 640 Water Supply: Public system ❑ Cla Adobe�Hardpan ❑ Gravel Sandy Loam ❑ Cla Loam ❑ Y ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ No Previous Application Made: Yes ❑ No New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: :(No septic tank or cesspool permitted if public sewer is available within 240 feet.) S tic Ta Distance from nearest well:---:----------- Dzeance from foundatiLnquid depth--Material---------Capacity____________________-- .VW41 No. of compartments___ lv CS 11'x` Distance from nearest well_.-CDU_�.-Distance from foundation. `--- Width coft}re�fest lot line � _ Disposal Field Len th of each line____--__ ❑ Number of lines--------------- g ! _ length Type of filter material------17%-----------Depth of filter material__.--- "" "" Distance to nearest lot line__________ Seepage Pit: ..---.,Depth Distance.to nearest well_._____-_"__-_-.___-"Distance from foundation____.-"-."""""-"--- De test l___.._""-•------- --- ❑ Number of pits------------------------Lining material----------------------Size: Diameter_-----------------�---- P ial Distance from nearest well-----------------Distance from foundation__------ " Lilning uid Capacity-, ------------------------ Cesspool: gals. Depth - ------- --- . a p Y ❑ Size: Diameter----- ----------------------- ---- p - ---- Privy: Distance.from nearest well-------------------------------------------------pistance from nearest building----------------------------- --------------- ❑ Distance to nearest lot ine------------------------ � ------------ Remodeling and/or repairing �descr e)------------ ----- _ _ -"------ ------------ - ---------)-I- --------------------- A— ------- �' t3 - -- ---- ---._.. -------------------------- -------------------- - -------------- ------------- ----------------"---------------------------------------------------- be I hereby certify that I have prepared this alli the San Joaquin LocalkHeall Disfrictn accordance with San Joaquin County wor ordinances, State laws, and rules and regulations - ----------------{Owner and/or Contractor). s� ned (Tit ep BY=------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY ----------------------- DATE------- -- - ti " ----------- ------------------------------------------ APPLICATION ACCEPTED BY ----- DATE -- - --- ------------------- --------------------- ----------------------------------------- REVIEWEDBY------------------------------- - - - _ DATE------------------------- ----------------- BUILDING PERMIT ISSUED----------------------- -------------------------------------- ---------- ---------__ and/or recommendations:--------------------- - ----------------------------_ --------------------------------------------------------------- ----------------------- ---------- ---- ------------------ ------------------------------------- ---------------------------------------------------- ------------�'--------�------ ----------------- ---------------------- -------------------- ----- FINAL INSPECTION BY:-_-_--.__ ----------- Date----- ------ ----- ------ ---------------- FINAL ---- ------------------------------------------- .. SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California �r a e,.A 0_9'3 R—iled W-2100