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APPLICATION FOR SDate Issued SANITATION PERMIT Permit No. ..... LL -.�� ' (Complete in Duplicate) .__.. .-.------•--- This Permit Expires 1 Year From Date Issued O 0-5 /(e O^t Z Application is hereby madetothe San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with •ounty Ordinance No. 549. • JOB ADDRESS AN LOCATION. . .. _ll �y , ------------------- � one Owner's Name--- .. ............................... Phme-[/ Address----. Ph ,j _ [ ----------•--- -- . one �--. ....-! 1 . .............. . _ Contractors Name ----------------------•--------••--- ❑ Motel Other •--- - .. . _ �- -------• Installation will serve: Residence [j Apartment House ❑ Commercial E] Traile.r�Court ❑ ' � L t size . ..��' ..._ Number of living units: -------- Number of bedrooms ..-..... Numbe/r of bath ..... Private � De th to Water Table 2P ft. Wafer Supply: Public system El Community system ❑ LYJ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan G-_ Previous Application Made: Yes ❑ No t[ New Construction: Yes ❑ No 2j--FHA/VA: Yes (] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) aft k: Distance from nearest well..................Distance from foundation-- -------- -Material........... _- -------- --------- ----------- No. of compartments-- - ..._:_�. ..........Size---------- ----------------- Liquid depth._.. Capacity �..... Disposal rFi d: Distance from nearest well.•�.�...:-....Distance from foundation _-_ f(� Distance to nearest lot line..._S.._..... Number of lines._..._._..-.....- -- Length of each line..... ------�.......Width of trench.......2 731..................... Depth of filter material...- ----------Total length..._......_3.C?...................... Type of filter material._.--- !. <-.. i t Seepage. Pit: Distance to nearest well.�GG_-••--_-•--Distance fpm foundation___`P__._.____Distance�e to nearest lot line................. �f De to �.................. Number of pits.._.-�-------------Lining material...�.p.�./`�-----Size: Diameter._..... .-.-.... . p Cesspool: Distance from nearest well-----------------Distance from foundation................. ..Lining material......--------------------...gals. ❑ ---•----..Liquid Capacity --- ............. Size: Diameter.--�---� ---•- --�--••----........Depth_................•-... ..----....----••--- � Privy: Distance from nearest well_.-__...-...._._______________...-.__... ...Distance from nearest building .-......-_-------------------••-•-•-•••• Distance to nearest lot line............................... ..................................................... --------------- ..... ----- Remodeling and/or repairing (describe):------- ...................... .. ............................................................ .................................... -----............................. ......--•.................... .................... . ' y...._.....y..that ----. --. _p._.p._-.---ulations of the San Joaquin Local Health District. ----cor ..._with__...n aq_.: ._ hereb certif that 1 have re ared this a lication and that the work will be done m accordance with San Joaquin County ordinance3, a laws, and rules and reg - ` (Signed)-- ---.. ....�-.1..�.r..�Il._¢__..>0_(l-S- •......................... ...............---•---••-----•----..........................................(Owner and/or Contractor By: ----------- ��r 11`�I t....._-----.-----_----_----••--•.......................•----••----. ._.. (Title).. -FS.��. - .. ..- (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 /L -------------- ----- DATE- .'3'L.A.._..............._...----•- --•-••. APPLICATION ACCEPTED BY...✓r ��d. REVIEWED BY. ...................... DATE......................................... .................. DATE---•-•--•---•................................................ BUILDING PERMIT ISSUED..............................................................—•........................_. ----------- .....-------..____---..._.___;..__..-- --•---------•-•---•...........---....---•-•---...-•-------------•-••-.................. Alterations and/or recommendations--------------- ..............................•---......... ............................................. • FINAL INSPECTION BY:.. -----... Date. .3 �4--�...-._--------------- - --------- ---------------•-• . . .. .- .. . -- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y.