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APPLICATION FOR SANITATION PERMIT Permit No. .__.?_.Z._9---.. (Complete in Duplicate} Date Issued --- /YaS _. ApP lice*ion is hereby made to the San Joaquin Local Health INoc for a permit to construct and install the work herein described. 49- This application is made in compliance with County Ordinance - �- � ---------- ---------------------- --•--- JOB ADDRESS AND L CATI N---=--- ---------. -�---- _ - ----•--- • -------------------------------- ----------- ---------------- - ---- Phone.---•------•----------•--•------•--• Owner's Name.-----• •- ----= Address.-----•- ------- <'`—- ----•--•-- cs^� :---- - ------ - one----------------------------------- . ----------•------------•-------•- ` - -------------------- P Contractor's Name_ Motel ❑ Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve:' Residence �—AP J- _-f _ - --------------- I____ Number of bedrooms . Au.. Number of baths .-/-_ Lot size --___ . _ Number of living units: _/ Private ❑ Depth to Water Table ft. Water Supply: Public system Community.system ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe�-Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y Previous Application Made: Yes ❑ No 1� . New Construction: Yes' No El TYPE OF INSTALLATION AND SPECIFICATIONS: \\' (No septic tank or cesspool permitted if public sewer is available within 200 feet.` �. ,.. _ istance from foundation__7Q--_---.----.Ma�enaL-"-�--L�- '--"------Distance from from nearest well"_/ Gf Septic Tank: Size .� • X,.4 6_Liquid depth ---- --------- .CapautY Q r No. of compartments_._--" ::, BTstance from foundation__/._�--------Distance to nearest lot line." `�t�----• Disposal Fie4d: Distance from nearest well-,/`�--" Length of each line______ Width of trench___.-- - Number of lines_--- •--/"---.....Tr----- g c r Type of filter material---- O.'Depth of filter materia l__-_.f .. "`--Total length------ � ! stance from f unc�ation.. 0•---- Distance to nearest lot line-"" .----- Distance to nearest well_^off �``� Depth--- Seepage Pit: - - e Diameter__"-�- Number of pits_---.___----------Lining material --- - Distance.from 'nearest well___-------------Distance from foundation-_.__.-------------ILmui Capacitytlgals. Cesspool: ---'-.Deth-------------------------------------- ------------ q Size: Diameter---------------- -------" ❑ ---Distance from nearest building Privy: Distance frori nearest well------------------------ - --------------------------------- F-1 -•------- ---- ------------- ❑ Distance to nearest lot line-----------�- ---- , ----- . - -- ----------------- Remodeling and/or repairing (des cri a ------------------- - � __ _---_-----.---_._____. - == ; ----•----------------------- - -----" = ----------- ---------••--------•---------•------•------------cor e .1 A • ---•--qui be I hereby certify that I have'prepared this ons application the San Joaquin the Local Health h p ne n accordance with San Joaquin County ordinances, St a ws, and rules and regulations (Owner and/or Contractor] - ------------ --------------------------------- (Signed). I (Title} ----- can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., J FOR DEPARTMENT USE ONLY IDATE----- —----------------------------------------------- APPLICATION ACCEPTED B = -------------- -------• DAT -------- ", --------- -------------------------- REVIEWED BY------------------------------------------- -- DATE_. 7----------------------------------------------------- BUILDING PERMIT ISSUED--------------•----------------- Alterations and/or recommendations•---------------- --- •A_ ---- -------------------------------------------------------- - _ --•--•-••---•-- ---- .. f •----------- ------- --•-- --------------------•---------- Date__._ -- ----- FINAL INSPECTION BY:_.---: • SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" strut 300 West Oak Street 132 Sycamore Street Tracy, California . 130 South American Street Lodi, California Manteca, California Stockton, California Es 7-2M 145446 ATWOO� 1�"54