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FOR OFFICE USE: �;.. -----------" --------- ------- ---------------------- --- APPLICATION FOR SANITATION PERMIT Permit No. -- ------ ----------- I --------------------------------------- ------------ a (Complete in Duplicate) n Date Issued This Permit Expires 1 Year From Date Issued I --- ---- -------- This- -- I --------- pp - - y A lica.ion is hereby made to the San Joaquin CLocal Health District for o a permit to construe and ins#all the work herein describe. This application is made in compliance w Y �}_ 4�__V_ix_ ` ---- "`Y'------`---------- - --- -------- -- JOB ADDRESS AND CATION. a Phone------------ I l -' ----------=------------ -- -- Owner s Name------- -----•- ---------------------- - Address-----•------ � Phone----•-----•----•------•---------•-- i - ----------- Contractor's Name------- ------------ Motel C] Other ❑ Installation will serve: Residence Apartment House F1 Corn ❑ Trailer Court ❑ Lot size Number of living units: _-L- Number of-bed rooms,Q- Numb`eriof baths PriJate"❑ `Depth to-Water Table _-. ft. Water Supply: 'Public system ❑ -.Community system,'❑': Hardpan Character of soil,to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay YesLoa ❑ Nol❑ F A/VA: Yay �Adobe ❑es ❑ No ❑ Previous Application Made:._llf yesdate-_-------- 1 No ❑ New Construction. ❑ TYPE OF INSTALLATION AND SPECIFICATION ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest yell------------- ---Distance from foundation-------------------Material._-----"-__---_p city- -- - --'-----.--- ' --Li Liquid de th-------------------------Capacity No. of compartments---1----- ---------------Size-_- T=-------------- q P. ❑ _ Disposal field: Distance from nearest well-.;'-., -----I Distance from foundations--� - Distance tofttrenche -j Ione"-_- _=:-------- E Number of lines---------- ------}length of each line--_-, �s n i rf Total len th_" "� Type of filter material.,= -- -i- f Depth f filter material"--_ -----+-- g ' a e Pit: Distance to nearest well_.-- p-- ---=Distance from foundation--_: Q Distance to nearest lot line--.�-" ----- Seep g Size: Diameter-------�_ -- ---Depth__ - ----- . � - ❑ Number of pitsi------- :-k--_----Lining-material --- --.��--,- -- ing Cesspool: Distance from nearest-well__----_"-__ distance from foundation_--_"-_---- -Liinuid Capacity ---_gals. Size: Diameter.�j. Depth-- q P Y ❑ _---Distance from nearest building_----.---_--------------------------- f Privy: Distance from nearest we ------------- -_-_---_----_-----_-- ❑ Distance to nearest lot:line.-._-------------- ---- - ---------------------------------------- --------------------- --- -------------------------------------------- ----- --------------------"-----•-------------- Remodeling and/or repairing (desc e}: ---------------- i � / --------------------- -- ---------------------------- ---------------------- ----------------------------------------------------------. ------'----------- hereby certi y at I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Stat w and rules:and regulations of the San Joaquin Local Health District. d/o (Signed) -- ---- ----- -- --------- ------- ------ ---- -- ---------------------- -- ------ -------- -- rContractor) y, �.---r- ----- -------- --------------------- - 9 _ buildin s, etc., can be placed on reverse side). (Plot plan, showin size of lot, location of syst in rel n to wells, FOR DEPARTMENT USE ONLY t ------- ----------------- -------- DATE--"- __ -LP j APPLICATION ACCEPTED 8Y___ DATE------------------------ - ------------------------------ _ ------------ -------------- -------= ----- - ---= -------- --- --------------- REVIEWED BY------------------- ---�- ----------- DATE------------------------------------------------------------ BUILDING --------- -------------------------------- -- BUILDING PERMIT ISSUED--------#}------------------------- - Alterations and/or reCommen a ions:_-----"--.----.-- ------"- 1 ---------- ------------ -------- ---------- -------------------- -------- ------------------- ------------- I { � --- Date--=: -- --- -------- -------- --- ---- ........ -------------------------- FINAL INSPECTION BY:---- - - ---------. SAN JOAQUIN LOCAL HEALTH DISTRICT 1 dal E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Lodi,California Manteca,California Tracy,California Stockton,California j