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Permit APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ------ itation is hereby made to the San Joaquin Loc --- a! Health District for a permit to construct and install the work herein described. Al This application is made in compliance with County Ordinance No. 549. �R1�°o�N------ 1?!� -------------------- JOB ADDRESS AND LOCATION...f �� f/X Phone I Owner's Name M } ------------------------------ -•-------- Address-------•--------••---------•-----------------• -------- -------- ----- ------------------- ---- ----- Phone--------- -40-7- Contractor's Name-------------------------- A ------ l Trailer Court El Motel N Other ❑ Installation will serve: Residence ❑ Apartment House ED Commercial ❑ p .__ Lot size -_11P-----Y'--- `---------------------- Number of living units: _"_ -- Number of bedrooms9_____ Number of De paths .th to"Water Table� ft.4- Water Supply: Public system El Community system El Private �/ # Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe 18 Hardpan ❑ Character of soil to a depth of 3 feet:' Sand ❑ ❑ Y No ❑tel!� �ln.&7e454 e� Previous Application Made: Yes ❑ No New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y r, Se tic'Ta k: Distance from nearest wel!_________________Distance from foundation--------------_____.MateriaL__-____..___""___-.____"_-___..____------------- t[. �p(Or No.7of compartments------------------- Size Liquid depth, Capacity Dis oral yField: Distancd from nearest well_________________Distance from foundation-----------------.-.Distance to nearest lot line__________ Number of lines---------------------------------- Length of each line -Width of trench ---_Depth of filter material----------------------Total length-----------•------------------------------ Type of filter material______-________-___ p Distance from 4f�o�u�ndation_-_____-__.Distance to nearest lot line___ --- Seepage Pit: Distance to nearest well-110Q---'f'.-- � Size: Diameter____�.8��-----.Depth f----------------- A ---------- `-- ANumber of pits---I-___--___-_-i_----Lining materiaLee�uS--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ---------------- --.____.___ _________-_...__._---_- = gas. -----------------.Depth------- ------------- -------------------------- Li Liquid Capacity ❑ Size: Diameter . Privy: Distance from nearest ��rell---------------------- -- ----- --- Distance from nearest building____-_--------------------------------- ❑ Distance to nearest lot line-- ----------- --------- ---------------- Remodeling and/or repairing (describe):-____-_."_--____---___________________ __ --------------------------------------------------------- -------------------------- ---------------------------------•----•------------•---------------------i------------- ---------------------------------- I --------------- ----•---- ---------------•-----•------------•------------------------------------------------- ---------- .............. r ------------------------------•--y--------------- ----------•- I hereb rtif that I have;pr pared this application and that the work will be done in accordance with San Joaquin County ordinances,pt e laws, andIes a d regulations of the San Joaquin Local Health District. P Contractor) I - ( (Signed) - -- --- ----------------- -------- -- -- ----------------- -- ------------- (Plot plan, showing size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side). F DE RTMENT.USE ONLY �/ J ??----------- APPLICATION ACCEPTED BY---------- 1� _---- ---------•---------•------- DATE �.3 rDATE----------------- ------------------------------------- REVIEWED -•----:----------•----------------- REVIEWEDBY-----------------------"---:------------------------------------------------ ------------------ BUILDING PERMIT ISSUED------ --------------------- ------------------------------------------------------- IDATE Alterations and/or recommendations:----------------------------------------------------------- ---------------------------------------- ------------------ -----------------------------------------------•-- •----- --------- 6 I i ----------------------- FINAL INSPECTION BY:.�___.__--��--�'- '-�'n" ----- - --------- Date--------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT . 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M io-52 Revised'W-2100y�