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I( ek lip APPLICATION FOR SANITATION PERMIT Permit No. --.•----- ---- (Complete in Duplicate) Date Issued 31`00(f This permit Ex fires 1 Year From Date Issued to construct and install the work herein described. Applicationis hereby made to the San Joaquin Local Health District for a permit e in compliance with This application is madounty Ordinance No. 549. - ----- / 7 ------------------------- Jp$ ADDRESS AND LOCATION____ � ."__"___"_ phone_..__.____. ' -�--- - ------•-----•-----•------ ---------•----•--------- Owner's Name--------- ----------------•-------------- Address------------------•---- / ----------------------•------------- Phone---..._-.----------------•--------- ----•----- ---------------- - Other Contractor's Name___-----•------------•- - Motel ❑ ❑ rCommercial ❑ Trailer Court ❑ House ❑ , - Y _______ j Installation will serve: Residence 2----ApartmentLot size�! f --"- -__ Number of baths _ Number of living units: __ --- Number of bedrooms T .� 1` Priva}g� Depth to Water Table _f �ft. Community `stem �_ Adobe Hardpan ❑ Water Supply:. Public'system ❑ - Cla Co_r; ❑ C4ay ❑ r Gravel ❑ Saridy Loam"❑ Y �Tdo ❑ I Character of soil to a depth of 3 feet: Sa_nd�� ew Construction. Yes �No THA/VA. Yes ! Previous Application Made: Yes ❑ 1`lo'L�;' I TYPE OF INSTALLATION AND SPECIFICATIONS: Pu sewer is available within 200 feet.) (No septic tank or cesspool permitted if p �� Material------------------ - I Distance from n Brest well--""" - Distance from fogundation_-_ - L/ Ca acit ��G�" ----"". Septic Tank: ----- ---Liquid depth----1"--�------------- P t i Na. of compartments------ -------------- � f �' _ Distance from foundation____.`----•---Distance to nearest lot lj`--------------- Disposal elcl: Distance from nearest well_,-_.--- -- - �� Width;of trench.----------41 ----------- Number of lines__ _____ '- ---- -Length of each line__ Total length--___�s �-- I � th of filter material__-1 �� Type of filter material_f"�"- Q -DE Distance #o nearest lot line--° -/• _ p,4 -- Size: Diameter---- > ... -----_Depth------��-a�" ------------ Seepage Pit: Distance,.#o neares II- Wingteral � anon_ Number of pits._- ----- -._ 4 Cesspool Dis#ance from nearest well-________________hep}hce from foundation--------------------____Liquid'Capacity--- ---------- gals. ❑ Size: Diameter.-d--------------------------- Privy: Distance from nearest well------------------ ----------------------- ---- Distance.'from nearest building" _------------------------- ----------------- -------- ;� ❑ Distance to nearest lot nine -------------------------------------------------- ---f � �/ ---------- Remodeling and/or repairing (describe:- ----- -------------------------------- _______________________________�_\___-___________-__.______.______________._._________. ________.____._--_-. 11 ___________________________________ __________.--____-_____--_____-_ ________________________________�----------------------------------_____-_________.___-___--____-_____-________________-_-_____ I hereby certify that I have;,prepared this application 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. '3f � r Contract �� f ° (Signed)------------------ �_. (Title) �/f ---- ---- -------------- BY: ---•--------- - etc.,.can be placed on reverse side). (Plot plan, showing size of lot, location system in relation +o wells, bui Ings, FOR DEPARTMENT USE ONLY l ------------------------------------------------------ DATE-------1__l-_"." - - -I ------ -------- - -- DATE_----- ---- - ---- -------------•----- ------ APPLICATION ACCEPTED BY___-_".- : - ' ---- ------------------- REVIEWED BY-------------------------------------------------------------------- ----_-------------- DATE------- ----------------------------------------------------- BUILDING PERMIT ISSUED-------------- Alterations and/or reco mendations-------------------- -' L 'a ---------_------------------------I--------T-------DE7-0 -- � 4 --------------------------------------------- -- ------------------------- ---------------- --- -- - l } Date- - ( -`- --------- -- --- ----------------•- EINAL INSPECT ON BY.. : SAN JOAQUIN LOCAL HEALTH DISTRICT L`� 1.32�Sytamore Street 814 North "C" Street „, 300 West Oak Sire®t.a� ", ';, _ ` Tracy. California 130 South American Street Manteca, Galifornia \t Stockton, California Lodi, California L ES-9-2M Revised 8-'59 F.P.Co.