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f-UK Urtica USE: I� I ------ - ------------------------------------------ ---- APPLICATION FOR SANITATION PERMIT Permit No. .. ... " _ .: (Complete in Duplicate) -"----------------------- ------------------ ----------- This Permit Expires 1 Year From Date Issued f Date Issued _ !i/164 Application is hereby macieyto.the-San Joaquin Local Health District for a permit to construct and install the work he ein described. This application is made in compliance with County"Ordinance No. 549. ;� - a. &j JOB ADDRESS AND L TION_Owner's Name___ _ -------- ------ ---------•--------- -------•Address----------- --_ --------- Contractor's Name___.___ - _- - one-------•-------•--•-------•-•-----• Installation will serve: Residante use Commercial Trailer Court ❑ Motel [] Other 9 ❑ ii (( Apartment HoE] CEl Trailer of living units: __l-___ Number-of bedrooms 3-- Number of baths :_ Lot"size __._-_ /q_---------- ------•-------------------- Water Supply: Public system ❑ Community system ❑ Private Rf Depth to Water Table __ ft. " Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loani"❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: �If yes, ate_..__._.___.__ No New Construction: Yes No ❑ FHA/VA: Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200,feet.) _ r1 Septic Tank: Disfance:�fropm nearest wel�90-------Distance from f6undation____--__10 �6-___ ---- --------------- - No. of com artments___-_________ ___________Size______ q-X-_ _ Liquid de th___ r1�� rq p. �y---------- ------------------ Disposal Field: Distance from nearest well--4'q-------Distance from foundation__ -1_-----_Di t , h s ante to nearest lot line_______ [�(] Number of lines------------- -- -- --------- i .---_. - Length of each line__ pj�__________Width of trench___ if Type of filter material- i---Depth of filter.material__�S_ __--_- '1 -----Total length----��--'S f------------ -------- Seepage Pit: Distance to nearest well--_____________.____Distance from foundation-------------------- Number ,Distance to nearest lot line________________ f pits------- --------------Lining material---------- ----------..Size: Diameter-----------------------Depth---- Cesspool:P Distance rom nearest _. „=" =-,:f _ �. : "i!• -�- well ❑ Size: Dca _________________ _ -Distance rom ounati_on______..__.____._--"Lining material_ _ ._-_____.__._ _ ---meter"--- ------ --- ----- ----- Depth--------- :---------------------------------Liquid Capacity------------------------_-ga_-gals.- Distance; � nweaest, ; well°r__ _-- -----_ -- +:Distance from nearest buildin _T________________ _ Distance El to nearest,lot lineg---- - ----- --------------•------- --------- Remodeling and/or repairingl(describe------------------------------------ �" -------- --- ----------- i ,. --------------------------------I -------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- I 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 r gulations of the San Joaquin Local Health District. t �y� d (Signed)________________ ____ __ .-. - {lt'_ --______(Owner and/or Contractor) $Y= -�- ------- •-•----•------- - (Title) (Plot plan, showing size of lot,',location of system in relation to wells, buildings, etc., can be placed on reverse side). h I� FOR DEPARTMENT USE ONLY r I APPLICATIONACCEPTED BY--- -- -------- ------- ------ ------------- ------------ ------------------ ------------ - DATE_------------�----------- ------ •------------------- ---- BUILDING BY---------------------------�----------•-------------------------------------- -- DATE. ' f PERMIT ISSUED-----"=--------------------------- - - _" f/- ---�"--- -•- - --- ----- _ ---------- -------- -- DATE------ Alterations and/or recommendsficins:_____...----_.___.___ - -------- -- -------------------------- ------------ - -------•------------- ----------- -------------- -------------------------------------------- --------- ------------------------------ ---- --------•----------------•-- FINAL INSPECTION BY:..............._---- -- - Date_ 1I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. l 4 West Oak Street ! 30 � -124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California I Tracy,California ES 9 REVISEa 8-59 3M 3-'63 F.P.CO. II