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APPLICATION FOR SANITATION PERMIT Permit No. 4------ _ (Complete in Duplicate) / Date issued __s✓__._ ` S Applica4ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance 54 JOB ADDRESS AND OCATiON-_----- ------------- wner's Name_________ -------- -- Address------ ----- �: --------------------------------------- __.__ _ _ Contractor's Name--- _ ---------- � --------••-------------------------------•---------------------------------- " - -- --- -- - --- -- --- --- Motel [3 Other E]Phone_ Installation will sery : Resid ce> Apartment House El Commercial ❑ Trailer Court ❑ # Number of living units: ._ Number of bedrooms -e Number of baths f Lot size wo- - Water Supply: Public system Community system I] Private ❑ Depth to Water Table, �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nov New Construction: Ye;K No ❑ TYPE OF INSTALLATION AND SPEC FI 1CATIONS: " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well rt2 ----Distance from fou d tion____ _� �( --------.Material _�Z 4 ---. /`� No, of com artments__ �Liquid depth______ r p .-- ------------------Size- Capacity - -- ----- Da_. Disposal Field: Distance from nearest well- .11 / Distance from foundation- Distance to nearest lot line----- -,--_- Number of lines_______-/_.._.- -_____ Len th of each line_---_- ✓ - --Length Type of filter material_ Width of trench_-_-___• _-_-- rr S�------------- - ------ -------- apt of filter material -- _ T tal length____._-____�--,•--`------••---••---- 5eepage Pit: Distance to nearest welt_ r ? 1.��( .��_____Distance f m fo da#ion�Q___-----.pis#an�e to nearest lot line-----�--� Number of pits______.___.__.____Lining material_ "� -Size: iameter__ ----------Depth------ -'�2 Cesspool: Distance from nearest well_______________ Distance from foundation------------------- Lining material_-_______.___._-__.______-_ -------- ❑ Size: Diameter ----------Depth--------------------------------- ---- -------------Liquid,CapacifY...------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building ; \ El Distance to nearest lot line--------- --------------------------------------------------- Remodeling and/or repairing (describe) _ 7- -Z- --------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, Stategla , nd rule n egulations of the $an Joaquin Local Heal#h bistric+. (Signed)________________ �on Owneraand/or"Contractor) BY� ----- --------Title ----`-_,/(Plot plan, showingszeof lot, iocation�of system in rela+ion to wells, buildings, etc., can be cerse sid FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------- - ----•----------- - DATE------------------- - - --- ` REVIEWED BY--------------------------------- - 4 tr---=��r---T-,�.�------------ ------ ----- DATE------------------------ UILDING PERMIT ISSUED. ------ - ------ Alterations and/or recommendations:-.---- '------- -- - -------------------------- _ • ____________ _______________ 4 r ________________________- --------------------------------------------------------------- _____________________________ v,-Y--------------------! --------- - -„ .. ---------- ----- ----- --------------------------------------- ----------------------------------- - li FINAL INSPECTION BY---- ---------- -- j� � Date (-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stackfon, California Lodi, California Manteca, California Tracy, California ES-4-2M "" Revised W-2100