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- � w APPLICATION FOR SANITATION PERMIT Permit No. _��--�---�-� (Complete in Duplicate) Date Issued 4// --5-��- 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 Or 'nance No. 549. �ks JOB ADDRESS AN OCAT�O ------ -- ------------ • � -" - .. Phone------------------------------------ Owner's Name----- inle Address-__.-_:_ .. • "/ ------ Phone------- "------------------------- Contractor's Name________________- -�-- - - - " Trailer Court ❑ Motel Installation will serve: Residence Apartment House El Commercial ❑ r❑ Other [] Number of living units: -1------ Number of bedrooms _-?..—Number of.baths --k----- Lot size ---S—_ `1- Water Supply: Public system ❑ Community system ElPrivate �epth to Water Table�ft• ;� i Character of soil to a depth of 3 feet: Sand ❑ Gravel El Loam E] Clay Loam El Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No R+ New Construction: Yes ❑ No ET, FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pubk'ceewer is available within Zoo feet.)r -----Distanc fro found tion____ Q-_---___Ma efial----)_ ------ Septic ank: Distance from nearest well--� _ "� Capacity Liquid de -f-h- P tY4_j No. of compartments------ ---------t--Size*3j<w�X=V�-- q Ip• ��.�rr��- ._Distance from founda ion--_ ,Q--- ---.Distance to nearest lotf line----- Field: Distance from neare SIL-•J'(�- . -Len Length of each line - of trench_ -. r___ d--_�----- Number of lines----- -_ 9 ------- Type of filter maferia4---_ p c 3z. �3 I len tli~--- e th of filter mater g -•-- )--'�'{a Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_ 7! --------Lining material-----------------------Size: Diameter-----------------------Depth------------- - `- ❑ Number of pits.-----_- -- � Cess ool: Distance from nearest well-----------------Distance from foundation__--___------_----_.Lining material-___.---- _��7 : Size: Diameter------- - ---------- ---- - D_e.pth-----�---------------• ---- p ---------------------S.-Liquid Capacity- --------------- gals. •-- = } ❑,lk s Privy: Distance from nearest well-------1----------------------------------------- Distance from nearest building-----------------------------------------. Distance to nearest lot li -- ------------------------- -------------- --------------- --------------------------- - ---------------------------------- Remo eling tat:. re ring [describe]: - -- ------------ _ �.- '�-- ----- -- --------- ------- -------- ------ ----- ! hereby certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------------------------- ----------------.-___(Owner and/or Contractor) --------------- ------- -- -----------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-B.Y.------- -:---------- ---- -- ----- ---- ---------:-------------------- DATE REVIEWED BY--------------------------------------------- - ----- - --- - -------- ----------------------------- DATE------ ---- ------------------------------------------� BUILDING PERMIT ISSUED----------------------------- ---------------------- DATE - Alterations and/or recommend ations------------------------------------------------------------------------------------ -------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----------------------------------- ---- ----- t FINAL INSPECTION BY:-----------_ ----- -------- -----'- ------- Date----- 1 ---------------------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT , 300 West Oak Street 132 Sycamore Street 814 North "C" Street f30 South American Street Tracy, California Stockton, California Lodi, California Manteca, California Y+ ES-4-2M Revised 1-57 FY.CO.