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SANITATION PERMIT Permit No. .-�l�S APPLICATION FOR SA /40 e�—:5 (Complete in DuplicatedDate Issued Ttt District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Locale Health D This application is made in compliance with County Ordinance No 49 ----- �--------- ----•-------------------------- JOB ADDRESS AND L CAT ON --- ---- --------- Phone------ :. -' - _:_ ------------------------- �. ---- Owner s Name------------- -------------- ---- _��j�, ----- -- on Address_--------•-------•-----•- - Y ---•'------------"---- Ph e`7f•�..---• `_. _- ----- r Contractor's Name___ _ _---•-•--- Motel ❑ Other Commercial ❑ Trailer Court ❑ ,�.,• Installation will serve: Reside e Apartment House ❑ �' "/ __ _____________ ` _. Lot size __--- --•- `�?/Number of baths __� . Number of living units: .__r-- Number of bedrooms -- Depth to Water Table' --ft. system ❑ Private [❑ DeP Adobe "'- Hardpan ❑ Water Supply: Public'systesn Clay Loam Clay ❑ Gravel ❑ Sandy Loam ❑ y No Character of soil to a depth of 3 feet:' Sand ❑ ��FHA/VAt Yes ❑ode: Yes ❑ No New Construction: Yes ❑ Na Previous Application M TYPE OF INSTALLATION AND SPECIFICATIONS: F No Septic tank or cess ool permitted if public sewer is available within 200 feet.) { P _ PY----------------------- S�?T Distance from nearest well-----------------D1Zetance from foundation depth--Materia_-------R Ca-acit No. of compartments-_ __ ____ a field• Distance from nearest,well -- Distance #h of from each l ne_foundation------- -------- ---Width ofttrenchest of sne---- ----^--:--; pasr ' Number of lines---------------- ------------- 'Leng Type of filter material---------------------------"-Depth of filter Mat eria4_------------ ---- ---Total length.__.--"----------=----------------.•-"--- ti s � r �r -- De th__c -.- Distance to nearest well_ _1`t_Eh-�---Distance fro foundation �.�---------'D�s#ante to nearest lot 'sne_________________ 5eepa e Pit: e -- p Linin material_ _ _ _ Size: Diameter__-__ ` Number of pits--/-------------- g Cesspool: Distance from nearest well--------------------Distance from foundation -------------- Liquid Capacity -== gals. ❑ Size: Diameter-------------------- Distance from nearest well----------- ' Distance from nearest buil ing--------------------------------------- m...v _ -_•_: .- = - ----------- ------------- Privy'. - �. -" ❑ Distance to nearest lot line_---- " T II. _________________________ Remodeling and/or repairing (describe):_------- ' _____________------------ _______________________________________ _-___.___.__________.________.______._____ ----------- ----------------------•------ --------------------------------- ------------------------------ -------- --------------------------------------------------------•-------- -----••- ----------- - - - -- - -•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ions of the San Joa ui Local Health District. ordinances, Stat laws, and .rules an ,regale;' ontract j -( °r1 Si ned _ =---------- ------- -----(Title)---------- ---- ( g ---- --- _ --------•-----------_----------------tio-- -- - - - ---- By: -------- - (Plot plan, showing size of lot, location of system in relatid to we1ls,�buildin s, etc., can be place on reverse FOR DEPARTMENT USE ONLY E _ _ DATE f ' DATE- "'c -------------------- APPLICATION ACCEPTED BY - ------ - ------- -. - - ;1 DATE----------------------------------------------- BUILDING --------------- ----: REVIEWED BY--------------------------- - � -- -- ------ '---------------------- ------------------------- - PERMIT ISSUED ------------------------------ ----- Alterations and/or recommendations------------•-- - ----- ---- ----------------------'---_--.- ---------------------------- ------- _____________________________________ _..____--_____-_ __ _____ ------------ Date------- ----------3 - -------- -- ------------ l . FINAL INSPECTION BY:-_ = --- - -- -- I • SAN JOAQUIN LOCAL HEALTH DISTRICT 814 Horth „C.' Street 132 Sycamore Street Tracy, California Manteca, California- 130 South American Street nodi 300 West Oak Street California Stockton, California FS-4 2M , Revised 1-57 F.P.CO_