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FOR OFFICE USE: - ------- Permit Na. ----------------- ------------------------ -- APPLICATION FOR SANITATION PERMIT - -------------- ----------- - ----- ------- # (Complete-in Duplicate) __ Date Issued - --7; ' -- --------------- -----. .. This Permit Expires"! Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ----------------------------------------------------------- JOB ADDRESS AND LOCATION------ Phone-----------------------------------.7 - Owner's Name--------- -------- ----------- 1�'t'--- - -- -------•------•--------------- Address------ ----- ------------ F ----- Phone Contractor's Name--- . Motel Other ❑ Installation will serve: Residence ❑ Apartment House F] Commercial ❑ Trader Court [Ir ❑ Number of living units: -- _. Number of bedrooms -2— Number of baths-1---_ Lot size -. Water Supply: Public system EDY Communitysystem ❑ -Private [Depth to Water Table ft Hardpan Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Previous Application Made: (If yes,date-- .---- - ) No ff'_New Construction: Yes ❑ No gg" FHA/VA: Yes ❑ No 15' 1 TYPE OF INSTALLATION AND SPECIFICATIONS: public sewer is available within 200 feet.) (No septic tank or cesspool permitted if `Y 11 Septi TanF Distance from nearest well---------_-..--Distance from foundatide th-- ----- ' s -----------------apacity----------------------- No. ----- ---------- --- No. of compartments----------- -------- ----Size------------- ------ ---- LiquidP. ' V Distance from foundation--/6-------------Disfia a to nearest lot lie _.--------- Disposal F Distance from nearest well-a�_.-.-..._. q �J Number of lines------- ------- Length of each line-- 4----------------- ---- p --Width of trench--- ------------ (en th �Q �.. N7 De th of filter material__- -----------Total " g Type of filter materlal. �� ------ p t e t Distance from foundation-I&-.----------Dlstarpe to neprest lot line----�---•- Seepage Pit: Distance to nearest well - --__.. --- Q ,.:.. Number of pits_.-----j-------------Lining material------. [_ Sze: Diameter--._.- -- -De to---.-. ------------------ Cessspo I: Distance from earest well ----------------fie t}Ince from foundation :_..:. �iauid�Capacity-...------------------------gals• t ❑ Size: Diameter -. ------------- - ------------- p Distance from nearest well-------------------------------- ....Distance from nearest building.._---------------------------------- - I Privy: -------------------------- - ❑ - - ----------------------- ------------------------- --------------=---------------- Distance to nearest lot line ------------------- ---- I -- Remodeling and/or repairing (describe): :._.. --------------------------------------- I ----- - ------------------------------------------------- ---------- ---- --------•------------------------ -----------•------------------•----------- ------------1------------------------------------------------I----------------•------•--------------------------------------------------------•----•--- ---------- I l 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 gulations of the S Jo quin Lo I Health District. Y ---------- ---. .(Owner and/or Contractor) (Signed) -- ------- ...... ----- -------- z; ----------------- --- ------- . = Tale - - - ------------------------------------- - BY=------------------ ------------- ---- -- --------- - --- I [Plot plan, showing size of lot, location of sys+em in relation +o wells, buildings, etc., can be placed on reverse side). p PARTMENT USE ONLY / ` r rte- DATE......... , `f} �------•------------------- APPLICATION ACCEPTED "/ ---- --• ------- ----- DATE------------------------------------------------------ REVIEWED ---------------- - --------- ---------- --- REVIEWEDBY------------------------------------- ----- ---- BUILDING PERMIT ISSUED.--------- ------------- ------ -----•-- -------- ------- -- ----- --- -- DATE-------- -------- - -- -------- --------------------- -- Alterations and/or recommendatlQ-_-- -------- � --------- --- ---- --------- -------•----------------------•---------------- - ' �._/----------3V--- �- y 4 ��----iso --- -------- - ---- ------------------------------..-.-------------- --------------- --------- F r - - Date.. FINAL INSPECTION BY:. ---_ -AQUIN LOCAL HEALTH DISTRICT I124 Sycamore Street 205 West 9th Street 1601 E.Ha:elton Ave. : 300 west Oak Street Stockton,California Lodi,California Manteca,California Tracy,California E.H.9 2M 1.67 vanguard Press t