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FOR OFFICE USE: ------------------- APPLICATION FOR SANITATION PERMIT Permit No. . -�•-- i (Complete in Duplicate) Date Issued ___ � Y161 ------------- rom Date Issue - _... ---------,-.------- ----- - - - - --- -------- :The Permit Expires 1 Year F 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 Ordinance No. 549. cf JOB'IADDRESS AND LOCATI u A.- . ....--- =_- k. i! ------- Phone...... Owner's Name:---- ------------------------ pT Ad d cess--.--------- 1 3-- ----- ------ ------ ---••----------- o . I ` Pone Contractor's Name...... . q Trailer Court Motel Other ❑ Installation will serve- Residence Apartment House ommercial ❑ ❑ / ------- Lot size -- - ---- ---- 1 Number of living units: _` Number of bedrooms Number baths # Water Supply Public system ❑ Community system ❑ Private Depth to Water Table __.__-.- f� Il Clay Loam Clay ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ Y 1 Previous Application Made: (If yes,date...1 ---------------) No ❑ New Construction: Yes [INo E] FHA/VA. Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available,within 200 feet.) 'tic Tank: Distance from nearest well-----------------Distance from foundation________________ _Material___-- -_.:_ __-.-_..__.._-..__________.---"---. Septic --- --------.Size----------------- -------------Liquid depth---- ----------- -------- tion ❑ No. of compartments.____..___.. � / -r - r Disposa i le d. Distance from nearest well...-��__- Distance from foundation.Y__ .�-----Distance to nearest i Jt kine_-�---------_- Number of lines------------- ----- Length of each line-- -- g .- �� Width of ----------- ` Type of filter material.__.«a��- Depth of filter material_"__.� __-__ .____Total length--4_-"_._.._____--------------------------_ Se Pit: Distance to nearest well..___-/_�o-_ Dista a from f undation___ 0-�__._"_. t to nearest l�a# ne_ -__---:_: c Number of pits--------- ----Lining material_ ---- `---'--Size: Diameter-_-.3-3,77.-- - ---Depth------- h stance'fram foundation_________________..Lining material_�-------------------------•--- � Cesspool: Distance from nearest well___.______...__D.i - ---Li Liquid Capacity 4 gals._:. ❑ q p tY . ' Size: Diameter Depth I+ Distance from nearest building._; -- r- ---------- ------------�� Distance from nearest,wel!____:,_._.____°_-J------ Privy: _ , - .. ------------------- ------ -------------------------- ❑ Disfance`to nearest lot line--------------------- ------------ ------------ •-------- 1 ' Remodeling and/or repairing (describe) , g - 1 11 --------------------------------------------------- -------------------------------------- --------------- ------- -- ------- ----'---------------------------------------------------------------------------------------------- . ` ---------- -------------------------=--------------- ------ ---------------------- - ------------ --------------- - q Y I herebyEIS, ave prepared this application and that the work will be done in accordance with San Joaquin Count ► or rules and lations of the San Joaquin Local Health District. ILA S and/or Contractor) Si ned ---- -- - ( ;9 } ion --- -------- -------- --- ----------- - II �Y� ------- ----- - (Title) (Plot plan, showing size of lot, location of system in rely to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY _ 7— 1 =_ // DATE >^ 1; APPLICATION ACCEPTED BY--- --------------------------------" r J L REVIEWED BY------------------------------------------ ------------ ------------------------------------------------- ----------- DATE--------- --------`•--------------------------------------- L --------- --- - BUILDING PERMIT ISSUED------------------------------------------ -------------------_---------------------------------- DATE-------------------------------- : Alterations and/or recommend ations_----------_______ ...............•-------------------- ----------•----------------- ------------------------- ------------------ ti --------- ------------ ------------------------ -------------- .. --------- ---- ------ - - ----------------------------------- -- -------- ---------------------------- ---------------------------- e Date-- . y ----------- - ------------- --------------- "FINAL -------------------- "FINAL INSPECTION BY:. w - ll SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha>;alton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lotti,California Manteca,California Tracy,California r II' F.RrU- -