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FOR OFFICE USE: Permit No. APPLICATION FOR SANITATION PERMIT _• - -- ------ ---------- -- ------- ------------------------- -- (Complete in Duplicate) Date Issued ------ --------------------- 5 ' This Permit Expires 1 Year From Date Issue ' Application i- here-- made #-- the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is madyir� co li e�with ounty dinance No. 549. Ccrse.� �.�CJ `�;" r -r �� (o h - ---- --0-f---- • =--1- ------------------ Phone - JOB ADDRESS A OCATIO ^ &- Owner s Name----- ___ -__ _ / l � \ ... Phon - - -• Contractor's Nam d ---• Commercial Trailer Court ❑ Motel ❑ Other ❑ i C Installation will serve: Residence partment ouse ❑ ❑ Number of living units: ___/___ Number of bedrooms ;f� __ Number of baths - Lot size ___ D �� -4.-�--- -------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------• ft. Adobe E] Hardpan ❑ Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam ay Loam ❑ No lH FA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ -- `�- - "-T - - T --•4..-� .--.. (No septic tank or cesspool permi+#ed if public sewer is available within 200 feet.)s M .te al �ty Septi Tank: Distance from nearest w II_�QptJ------Distanie from fou dation___ _ f"PLi uid de th___ No. of compartments.__ -----------------Size_ ._ __3L_- -- - q P. ff / .......Distance to nearest lot line.___ Dispos I Field: Distance from nearest well_�?i�Q------Qlstance from founds ion__.__ ---Length of each line_-_ - -f-----------------Width of #rench_a q-!!-------�------------ Number of lines________ _ \ gV-A-------------- Type of filter materia t -----Depth of filter materlaL_f_ --- --______Total length__________________ Seepage Pit: Distance to nearest well----------- - ------Distance from foundation Distance to nearest lot line_.________._____. ❑ Number of pits----------------------Lining material--------- Size: Diameter Depth --- Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material--__.----___._._--__-----_-------els. ❑ 5ize: Diameter - ------------Depth--------------------- -i------------------ _Liquid Capacity 9 .L. -- -"- T r ! ------------- �. ____.__Distance from nearest building__________________________ Privy: Distance from nearest well____.__------------------------------ ❑ Distance to nearest lot ine---------------------- --- ---- ------- ---- - ------_------------------ It --------------------------------------------- .% __ F _ _ ______ __________ _ __________._________._______________ _______- ____ Remodeling and/or repairing (describe):-- --- -- ---------------- - ----- ------------ �.� -�-- - ---- - --------- ---------------- - ------------------------------ ---- --------------------------------------- i I hereby certify that I ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, an rules and regulations of +he San quip Local Health District. or Contractor I ---------------(� } ---- �; (Signed]_. a 9�` - t . - - _:-------(Title)--------- - -------------- ------------------------------------------------------------------------ (Plat plan, showing size of lot, location of system in relation # ells, buildings, #c., can be placed an reverse side}. FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY - ---------- DATE------------------------------- ----------------------------- __ _ DATE---•-------�-;�----------- ----�---------• ------ REVIEWED BY. - - DATE------------- --- ----------`- ----------------------- BUILDING PERMIT ISSUED---------------------------------- ----- Al#erations and/or recommendations:___----------------------------------- --------- ------------------- •----- --------------------------- - Date-- --- ---------- ------ _ ^- --------------- FINAL INSPECTION BY------------ ---------- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California IFS 9 REVISED 9-59 3M 3-•r.3 i-P.CO.