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FOR OFFICE USE: *x= Permit No. • - / ------------------------ APPLICATION FOR SANITATION PERMIT -------------- --------- ------------------- 1 (Complete in Duplicated Date Issued __---- ------ ---------------- ed. -..------� ---- - s This Permit Ex fres 1 Year From Date issued --------------------- ' o the San Joaquin Local Health District for a permit to construct and install the work herein described, 1 Application is hereby made t n} Ordinance No. 544. This application is made in compliance with County i 7 �--y' }---- Phone_ ,,rn�'---�'r`':---- JOB ADDRESS AND �O ATION------ ------------ - ----------- � �.� = �� - Owner s Name - �� ------- �: r Address------------------- ------------------------a one. --------- Other ----•----------------- Motel ❑ - -- -- ---"""'""- Trailer Court ❑ Contractor's Name------- Apartment House ❑ Commercial ❑ 7 p -3p, Installation will serve: Residence ❑ P �s De th to WateriTable 15'0- ft. Number of living units: _�_-- Number of bedrooms _Ij- Number of baths,-j-.- Lot size "-- - -"-- u Community system ❑ Private P Adobe Hardpan ❑ Water Supply: Public system ❑ [gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ Character of soil to a depth of 3 feet: . Sand ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i If es,date- - NO ❑ Previous Application Made: ( Y t TYPE OF INSTALLATION AND SPECIFICATIONS: No septic ta�+k o�cesspodl pe fitted ifublic sewer is'ava{obmefoun�da �`fev -- ' ( Maternal --=- -------- 49-------- ' Distance from nearest well----0--- -Siz,ante Liquid depth---jV--------- ---------Capacity-- �_. Septic Tank: compartments Size_ _ _ Nv, of comp ' r each line :_ Width of trench---- ------ pis osal Field: Distance from near st weli._�_d•-- --Distance from foundation.--J-a ------ Distance #o nearest lot line-- mfh otal length--_A P- ----------------� Number of lines___"_-.----------------"-Depth offf Iter material__-- >/- ----------- Type of j;lterr material t 3 Depth -S `= o nearest well------ Distance from foundation___-"----- -Distance #o nearest lot line_.--`---------- Type --- Seepage Pit: Distance t Size: Diameter----- ----- e Lining material__ __ Number of pits------y------- ---- 3 i ------- -- als. Distance from nearest wei4_--__-.--------Det}�ce from foundation----- ------------Liquid Capacity__--___----- -- ;;- g Cesspool: ------------ p ii Size: Diameter � ---------------------------- r ❑ -_--Distance from'nearest building-_ ---------- Distance from well = `. -- -------------------- Privy: - - = .•.� ❑ Distance to nearest lot line_..-------- -.- m ... i ----------"------------ ----------------------------------'------------ Remodeling--a--n--d--/--ow nd/or repairing (describe):_-_----------- ------"=--------•------------------------------- - - _ `_. ------------------.----- -------------------------------------•----------- Joaquinis County -""--------------- --------------------------------- ----------------------------- this application H n a th wok will HealthDistrict.cin accordance with San i I hereby ce ify that I havfi e prepared ordinances, Safi laws, and rules and r +dations of the 9 "�" (Owner and/or Contractor) C ---- (Signed) ------- ---- ----------- --------T p gy;_---- (Plot plan,.showi g size of lot, location of s em to relation to wells, buildings, etc., can be laced on reverse side). i .1 FOR DEPARTMENT USE ONLY a . 1 DATE `�f .��----------- ---------------------- DATE -------- APPLICATION ACCEPTED 13Y_.. --_------- BY--------------------- -----= - DATE-------------------------------------------- REVIEWED �, -- -------------------------------------- BUILDWG PERMIT ISSUED = ----------•------------ Alterations and/or recommendations:--------------------- - --"__"--.--_"-___.____" , ------------------------------------------- -------------- --------- --------- -------------------------------- ------ -------- --------------------------------------------- ------------- ------------- _ Date.- ------------ ------------ ------------ FINAL INSPECTION BY I SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th Street � 300 West Oak Street 124 Sycamore Street Tracy,California 1601 E.Haxelton Ave. Lodi,California Manteca,California Stockton,California Eg 9 REVISED 8_59 3M 3•'63 F•P•C a. •h