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i APPLICATION FOR SANITATION PERMIT Permit No. --f---- a (Complete in Duplicate) Date Issued ------------l---!y- , Application Is hereby made to the San Joaquin Local Heal&# 'District for a permit to construe# and install the work herein described. pp with County Ordinance No. 5 9. This application is made In compliance wi p k . JOB ADDRESS AND LOCATION_ • -=----- I� - ne------------------------------------ Owner's ------------- ------- ---------- Owner's Name------------- rte 1 ----_------- ---' Address__.------I�--------------- ------------- - ----•---------•--•------•--- - - ------- ------- - � Contractor's Name------------------ ---------- Address -------- p !Commercial Trailer Court ❑ Motel ❑• Other ❑ Installation will serve: Residence Apartment House❑ ❑ Number of living units: ___. ___Number of bedrooms -1 Number of baths ---[_ Lot size -----�-�-----�-lQ-�---------------•------�- I� Commun'it s stem ❑ Private Depth to Water Table- ft. Water Supply: Public aystem ❑ Y Y Adobe) Hardpan ❑ • • Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Character of f so�1 to a depth of 3 feet. ❑ r Previous AppcationMade: Yes ❑ No A New Construction: Yes [I No [ FHA/VA: Yes ❑ No, r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 240 feet.] rr , 1' pn - Distance from nearest well-----------------Distance from foundation---------_----------Material_ _._.__._____-__....___.._________-_.______.__. / ❑ Size--------------------------------Liquid depth---------------- ---------Capacity--•---------------- 1�: No. of compartments................ . Dispo eld- Distance from nearest well________________ Distance from foundation______._________._.Distance to nearest lot line----------- Number of lines---------------- --------------------Length of each line------------------------------Width of #ranch. Type of filter material----------------------_Depth of filter material._..------------�-----Total length---------------------- dN • . m Distance fro, foundation_`.-/ _.___.__.Distance to nearest lot line_�S'>------ Distance to nearest well.--/�_Q--:------- 1-r 7 -c-=t Seepa e Pit: Number of pits-------/------- ---Lining material------- —c_C�'Size: Diameter----�3------- -.Depth---- _- ------------------- Cesspool: Distance from nearest-well----------------"Distance from foundation.___.__'___.__.___.Lining material_.- __.____.___.____- De th-�--------------------------------------= #= Liquid Capacity----------------- ---•---gals. . ❑ � Size: Diameter------------------------------------------ p f --------Distance from nearest building------------------------------------------ Privy: Distance from nearest ural!----------------------------------------- n ❑ - Distance to newest lot line------------------ ------------------ -------- -------------------------------- - ------------------------------- ----- - `7l s , Remodelin and/or repairing (describe)----- --- ----------------- - --------- pe - �� -_ --- ----------------- � ---•------- - ---------------------- -------- -- - -- --------------------- ----- ---------- -------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County egul 'ons of th a Joaquin Local Health District. ces, State laws, and rules a r }. 1 ordinan ° Owner and/or Contractor - --------------- ---------- _ (Signed).- ' ---- ---- c-- �------ --- - - ---- By:-=�---------- ------------------------- '4" f--- (Plot plan, showing size of lot, location�of sys em in relation to wells, builrll+�gs, etc., can be placed on reverse side). �I FOR DEPARTMENT USE ONLY I I - DATE---------- u�- -------------- APPLICATION ACCEPTED BY----- - ---------- ="' " -------�--------- ---------- DATE----------------------- --------------------------•--------- �M ---------------- BUVLDIE`IG PERMIT ISSUED---------------------------------------------------------- ----- -----------`----- ----------'--------------.---- --------------- DATE.---------------- ----------------•-------------------------• and/or reco en , t .�ic1 _ ,d "' �•� -or— fI- - ----------------- 14 � hu A ------- --------- Alt erata ns � __ _ ---- ----------------------------- r Date FINAL INSPECTION BY:- -- --- -- -- --- --- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT luth 814 North "C" Street 300 West Oek Street 132 Sycamore Street130 SoAmerican Street Tracy. California Stoekton, California Lodi, California Manteca, California Y ES-9-2M Revisea 1-57 F.P.CO.