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tea( APPLICATION FOR SANITATION PERMIT Permit No. Complete in Duplicate} Date Issued -- �� + W �\ e work herein described. he San Joaquin Local Health District for a permit to construct and install th Applies+ion is hereby made to'the This application is made m compliance with County Ordinance No. 549. ---- -- --------------------------- JOB ADDRESS AND LOCATION_________- ----61 -------- Phone------------------------ ---------------------------------------------------- ------. - !6l = Owner's Name----------------rt:a_-;;-- - -•---- - Address_ _ - --• :--------------------- ----------- ----------------------------------- Ph,�ne----------------------------------- Addresse----------------------------------- --- ------------•------------------• --.,.-. Motel ❑ her ❑ Contractor's Name------------------------------------- Commercial ❑ Trailer Court � Apartment House ❑ _ _11----------------- Installation ___ __ ----- Installation will serve: Residence [ p '1 Number of living units _______- Number of bedrooms 3-_.- Number of bahh+o-Wetero Table -------- system -t size ��ft. Num Private ❑ Dept I Public'system] Community system ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Water Supply: Gravel ❑ Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ Application Made: Yes ❑ k No New Construction: Yes " No ❑ Previous App i TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer stanceafromefoun'da iono_f 10----------Material_____________ `� '� y------ -5 -------- Septic Tank: Distance from nearest well----�Q-----D 4 Liquid depth--------- - ----- Capacity - No. of compartments----- Size____. Distance to nearest lot line.... Dis osal Field-. Distance from nearest well-.-.- -- ---_Distance from foundation__:_ -lO iS Number of lines---------- ----I----------Length of each line_ P__��- 0-_ Width of trench-------- Depth of filter material------1 fI . Total length___.___..-) 1 Type or filter material---------- I p 1, Distance from foundation--------------:----.Distance to nearest lot line----------------- � Seepage Pit: - Distance to nearest well------------ - '' i Number of pit ------- Lining material---------------- ----- QnDiameter---------Lining material p--------------------------------------- r ❑ Cesspool: Distance from earest well-----------------DistanCer from o -_--Liquid Capacity_---------------------------ga s. Depth-------------------------- ❑ ' Size: Diamefer---------------------------------- ----- ' Distance from nearest building------------- ---------------- �. Distance from nearest ural-----------•-- --------------------- ---- - ----------- -------- ---------------- ----------------------- Privy: ------------------------------------ I ❑ Distance to nearest lot line-- .._.. F Remodeling and/or repairing (describe):---------,rz --------------------------------------- - i. --- - ----- - Iication_and that the work will be done in accordance with San Joaquin County I hereby certify that I have,ulprepared this app ordinances, State laws, and rules-and regulations of the San Joaquin Local Health District. (Owner and/or Contractor ----- ---- ------ 5i ned --- --(Title)------ ----------- ---------- ------------- B. :_ ,� p laced on reverse side. (plot p , showing size of lot, 10'a (P10 of system in relation to wells, buildings, etc., can beplaced FOR DEPARTMENT USE ONLY DATE------ --- wr ------------------- - -- - -- APPLICATION ACCEPTED BY--------------- - --------_ DATE----------- ------------------------------------- ---------------- - --------- DATE------------------------ BY------------------------------------------------------ ----------- --------_4- - -- ------------------ ------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------- -------------- 5SUED---•------ ------------ --------- ----------- ------- --------------- Alterations and/or recommendations:---------- ---------- --- ---------------------- r I / / -- --- [f - r Date----- ----- -- ------- ------- --- ----- -- F1NAL INSPECTION BY:_____- --- -- ---- - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 014 North "C" Street 132 Sycamore Street Tracy, California 300 West Cek Street Manteca, California -130 South American Street Lodi, California Manteca, Stockton, California �.A P—;-d W-VOO