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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued -- ;' Application is hereby made to the San Joaquin Local Health.District_for a perm td construct and install the work herein described. 1 This application is made in compliance with County Ordinance No. 544. F ----------------------- ---------- k JOB ADDRESS AND LOCATION_.--- -Q P Phone------------------------------------ r- a -------- Owner's Name / - ---------- Address---------------------------------------------------------------- ------- Phone---•-•--•----------- ---•---------- - - -------------------------------- ------------ Contractor's Name------------------------------------------------------ ------------•------------------------- -------- �. -- �... Trailer Court Motel E]—.Other ❑ Installation will serve: Residence po Apartment House ❑ -Commercial ❑ , �� -1 1 A Number of living units: _/-___ Number of bedrooms _A- Number of baths .--�---rl_ofi size --------- ----- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -C---- ft. Adoba Hardpan ❑ PP Y= s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ y ❑ Previous Application Made: Yes ❑ No (K New Construction: Yes ❑ tNo ❑ 11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within ,0 feet.) ! � �-'--- - 1`f - -------. cr� Septic Tank: Distance from nearest well----�?D-"-�"'Distanc;from found��ionte al___ - � p Sixe__ _Capacity--•-F- ------ No. of compartments---------;�--- ----.-.- �•y--- -----*- squid depth i Disposal Field: Distance from nearest well__ p___yr'__.Distance from foundation'__3.a p'.Width ofnce ttre cnest lot line._______ _ -_ Number of lines-----------. ------ -Length of each line__6� 1r ® - �p ___Depth of filter material_-_�_?-----------Total length___-____la-0--------- Type of filter materiaL__��-�8-- - P Seepage Pit: Distance to nearest well _------ material e from foundsz npiameter"_ Distance to nearest lot line--------- ------ ❑ Number of pits---.-_ -- g #.� ing ------------------------------------- Distance __ _ _ k gals. Cesspool: Distance from nearest well _____ _ __ -__Distance from foundation�-. � _;� Liquid Capacity -9 Depth----- �`"'�"--_ p tY--.-----•-------- t__... Size: Diameter_ _ M q r g �_. ❑ -� -- -- --- ----- Distance from nearest well_" - ::Dsstan�e roam Wena es buil -- ------ - --- Privy: 1`4►. - t.,......................................--------- ------- Distance -- -- ❑ Distance to nearest of sne---------------------- --- -------------------------------------- Remodeling and/or repairing (describe}------ ---------- ----------- ----" --------------------------------------------- ---- x ------------ ------------- n ______ ----- t I have* re ared this application}.and-that.the work will be,done.•in accordance with San Joaquin County 1 hereby certify that P P ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i^ t _- ______(Owner and/or Contractor) ---- Title By------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildin ti eta., can be placed on reverse side}. t FOR D�P RTM T USE NLY -_- -- --- .-- --�- - � `'--'` DATE-------- �s -3---------------- APPLICATION ACCEPTED BY----- REVIEWED BY---------------------------- DATE 'r - --------------------�-•-- ----- �--------- -------- ------�--------- DATE--------•---------------=-�- -----•-- -�-----------------�-- BUILDING PERMIT ISSUED-------------------------- - ......•------------------------------------- .--------•--- Alterations and/or recommendat1ons:__ - -"--- .. -,•. -------------- L" -•--•- ---- -------- ----------------------- /' ----------------------------------------• ----------- -------------------------:----------------------------------------- ----------t----------------------- -------- ----- -------------------------------------- ------ i Date------------------------ . .. ------ ------- FINAL INSPECTION BY:------ ------------------------ - ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore 5}naafi 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stock+on, California Lodi, California Manteca, California ES-9-2M 10-52 Revised W-2100