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1 - APPLICATION FOR SANITATION PERMIT Permit Na. �! r/ • � (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei escr' ed. This ap licatiori is made in compliance with County Ordinance No. 549. �� - €1 Ufa�3 JOB ADDRESS AND LOCATION ' --- - Owner's Name------------- -------------------------- RV- Phone----•--=----------------------•---- -,. --------------------------•----- r Addressone I � Contractor's Name--------------�-------- ----- ----- r Installation will serve: Residence Apartment blouse El Commercial ❑" Trailer Court ❑ Motel ❑ Other [I - Number of living units: -1-Al-Number Number of bedrooms __,Zr_-.Number of baths __ __ Lot size ---47--I<------ -- ------ Water Supply: Public system' Community system ❑ Private ❑' Depth to Water Table __09f t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Na �° FHA/� Yes❑ No Previous Application Made: Yes ❑ No New Construction:µYes .❑ X TYPE OF INSTALLATION AND SPECIFICATIONS: /// (No septic tank or cesspool permitted if public sewer is available within 240 feet.) tic T Distance from,'n garestwell:_ ------Distance from foundation___________________Material------------------------------------------------ No. of compartments = ------Size----------------- ---Liquid depth Capacity.. J k, Discos field: Distance from.nearest ell__,______�____'_.Distance from foundation_._______________.Distance to nearest lot line_________________ Number of lines----_-------�- ------ -------Length of each line------------------------- Width of trench-_------------------:---- -- TY' e of filter•materia4---------- #- -----Depth of filter material------------- --�---Total length-------------------------------•------ .el __Distance f m foundation__.__�' ____._..Distan�c�e to nearest lot line--- -..__ Seepage Pit: Distance to nearest yell___ _ _ Size: Diameter____' _____. _ Number of pit-----------------------Lining material---- Depth------ '`---- Cesspool: Distance from nearest well_________________Distance from foundation_.__--__________---Lining material-------------------------------------- ❑ Size: Diameter------ --------- ---- ---- ----_ m ' Depth----------------------------- ----------------------Liquid Capacity----------------------------gal Distance to nearest lot line'____ ______________--__.__..____---_ Stance from nearest building._________-_________--------------------- Privy: Distance from nearest v�ell___.____-____t- """ `--- - -------------- - :a - T I ; - '�.. 33 � ,fes/.r �r Remodeling and/or repairing (describe):---------- -------------------------------------------- _ ----------- -- --------------------------------------------------- -------------------------------- - + q I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules,and r gulati sof t an Joaquin Local Health District. s.: (Owner and/or Contractor) _Z/----- ------ (Signed) _-- _ _ �Trt (Plot plan. showing size of lot, location of system in relation to wells, bu' ' gs, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ DATE-- a--------------------------------------------------- DATE-- -V ------------ ------------------------ BY-------------- -------------- DATE------ ------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- !r�- Alterations and/or recommendations:_______________________.___-_.____.._.._-_ ------------------------------------ ------------------------------ -- ---------------------------------- ------- --•-- ------------------- ------ -------------------------------- ------------------------------------------------ --- ---------------------------- - ---------------------------- --- -----------•---------------------------- --------------- --- ---- - / FINAL INSPECTION BY__________ --------------------------- Date-- - -- ------•------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised 1.57 F-P.CO-