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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No. ---------- -------- -------- .........1J.1...._...,I...�- _� II ----- ------------ (Complete in Du licate} Date Issued .. ------------------------ _- --_------ ---------_------__-._...__...___.__- This Permit Expires 1 Year From Date Issued �5 Application is hereby made to the San Joaquin Local Health District for a permit to construct a inalf t�e wor�Fe �ribe,� This application,.is made in,complianc ith County Ordinance No. 5 G 0 Com© t4 ,t _ w �, JOB�ADDRI;SS AN CATI N •------• ----•- Owner's Name_ pp // . Phone.... Address..............._.--------•----.P.... L� .. - - ...... =ell -------------------•----....----------------------------•------------- Contractor's Narlie----------______L: Trailer Court Motel Phone❑ Other ��"' ---------------------•--•--------•----------•--------------. ia,�j installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ ❑ Number of living units: _-__-___ Number of bedrooms --r-----. Number of baths -___-.__ Lot size ..... .............. Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table . . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandys Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: llf yes,date....................) No ❑ New Construction: Yes gj' iso FHA/VA: Yes ❑ No ❑ F, TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if publicseweris available within 200 feet.) ,. Septic To Distance from nearest well._- -------Distanp from foun4ation.____--M_____;..-_.Mate0al... .............. .... . No. of compartments.---.07- --- q P. -------------.Capacity S`dd , � _-fi Distance from foundation__•,(Q. ------Distance to nearest lot !i fe,l ?.+a..... Disposal ield: Distance from nearest well-40 Number of lines______________ ____ ___________Length of each line------__.__=___._� .Width of trench.... 0 ----- Type of filter ma+erial. r.l0C-�...Depth of filter materia _____________Total length.......... ___L?.__._____.....----•--.I~ 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----------...______--•-•-.-____-.....f ^� 171 Size- Diameter----------- ------Depth----------------•-------------------------------•--Liquid Capacity-------•-----------•--------gals:; Privy: Distance from nearest well------------------------------------------- -Distance from nearest buildingi ❑ Distance to nearest lotline-------•-----------•---------- ------ -------.................. ....------------------------------------ ------------------------------ ",,.e ---•-•---------- ---•-- Remodeling and/or repairing (describe):__ 0--- �'�' -------•--- ---•-••----- -----------•------- - ------------- i ----- Ad. ----------- I ---- E .....-- --•--------••-----•-------------------•----------••-----.-------------------------•--------------•------ -------------------•-- I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County! i ordinances, St ws, and,ruf s and regul ns of the San Joaquin Local Health District. ' {(Signed) ti :.. 2 .. ----- ---- nor end/or Contrector)L-w 9 } Title ------------- ---------- ----------••-------•--------•---------------------------------------- { } (Plot plan, showing siie of lot, location of'system in F anon to wells;buildi c., c`ari'be placed on reverse side). FOR DEPARTMENT US ONLY APPLICATIONACCEPTED BY---------------------------------------------------------•--•----------------------------------- ATE------------------------------------------------------------- REVIEWEDBY--------------------------------------------- ---------------------------------------------------------------------•---•-•--• TE---------------------------•-------------................... BUILDING PERMIT ISSUED--------------------- - ------------- ------ D T -�-- ` -------------------- Alterations and/or recommendations:..---- ---- ------- --- `! W----•--------------------- -------------------.._...---- -------------------- ---------- ........._._....-----------.---------- �------------------- ---- -----------. ------------------ --------------------_ ; . �' -------------------- ----- ------------------------------------ --- 4 FINAL INSPECTION BY:..._ -- ------ Dat �-----------------------------------------= ------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Streit Stockton,California Lodi,California Manteca,California Tracy,California E6 9 AEV18ED 8-69 2M a-61 ATLAS f