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/jyf�F�©R OFFICE USE: I ------ APPLICATION FOR SANITATION PERMIT Permit No. ...�.` -----••- `---__--- -- (Complete in Duplicate) Date Issued ----- 65 y This Permit Expires 1 Year From Date Issued ----------- ------------------- ------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described? This application is made in compliance with County Ordinance No. 549. ]` JOB ADDRESS AND LOCATION___ r. y-- ' - � f• �`' --- ------------------------"------------------------------- ---------- _ _ _ I ,. Phone------------------ -------- --------------------------------------- ------ -- -- 1 Contractor's Name------ - -.---• - � Commercial Trailer Court Motel ❑ Other ❑ Installation will serve: Residence {��partment House ❑ I ❑ __ Number of baths Lot size/e ----------------------•- Number of living units: _--_---- Number of bedrooms �-- Depth to Water Table "ft. Water Supply: Public system ❑ Community system private ❑ ❑ Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ClayLoam Clay ❑ U ❑ k Previous Application Made: (if yes date.__._._---- ---) No New Construction: Yes [6--No ❑ FHA/VA: Yes 5p-- No ❑ N pP t ... _ N TYPE OF INSTALLATION AND SPECIFICATIONS: 1'n (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` a -----Distance fouundafio�n---. Jr--------.Materia4_. _ __ - --- -------- Sep#sc Tank: Distance from nearest we _-.--__ Capacity_ - ----- No. of compartments--- - ------------------Size�,Z - Liquid depth__ .--._.. 01 Disposal Field: Distance from neares well__-'�"-------Distance from foundation._ :�--.- ..Distance to nearest lot line---4 -.----- .Len Length of each line--s� -"-__-- ----"-------.Width of trench--+ ------"----------------"-- Number of lines-- --- ---"-."- - g _fi Type of filter matarial__s % Depth of filter material___ ---�----Total length__., -------------- {. �s ��----_.-.Distance to nearest of line_ -_.__------- Seepage Pit: Distance to nearest well__."__°.---------Distance fr,m foundation-__- _ ___ ry p .Size: Diameter- - - _. -- ---De th_ - � Number.of pits.;.------------Lining materiaL__ Q�� Barest well_--_-___.-----_-Distance from foundation............_--...Lining material__--------------------------- ---- Distance from Cess❑ool: ize: D ameter_ l -------Depth--------------------------- = -------------Liquid Capacity--------------------------9 P ---- --------------------- fDistance from nearest building---------------------------------- Privy: Distance from nearest well____-------------------------------------------- F ❑ Distance to nearest lot line------- - ( � -4 - ------------------------------------------------- -------- Remodeling and/or repairing (describe :__-. _ i ------------------------------------- , ------------ -----••----------------- A " -----------l here- - b certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ----- - Y Y ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. i r Contractor) ---------------- ` (Si ned) ------- (Plot - ---(Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY i _. k APPLICATION ACCEPTED BY-__ —�"`------------------- --- DATE ----�- DATE--------------------------------- ------------------------- REVIEWED BY------------------------------------------ -- ---- ----------------- - --- DATE - ---"----------------" ------------------------------- BUILDING PERMIT ISSUED--------- - --------- _ � - Al+erations and/or recommendations - _ �lf ------------� --------- ----- --------------------------------•_-;? _--aS .- . -------------------------------------------------------•--.------- (a Date--"--- - ---------------------- FINAL INSPECTION BY------ ---- -- ........ �"`-- _ SAN JOAQUIN LOCAL HEALTH DISTRICT �' w 1501 E.Hn:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street - Lodi,California Manteca,California Tracy,California � Stockton,California F.P.CC.