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FOR OFFICE USE: s .y ------ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___/...7,Ff ------------------------ (Complete in Duplicate) Y.. Date Issued --- ------- ----- _--- -------- ------ ------------------------ This Permit Expires l Year From Date Issued _f7 0 -o y Application is hereby made to the San Joaquin Local Health District for a permit t construct and install the work Kerein described. This application.,is..maderin compliance with-County Ordinance No. 549- I' JOB ADDRESS 4AND ---- -•-- - - - Owner's Name-- ' ----•--- `" _ Phone__ :_�__ _ _ ._� Address--------------- t3 .... -x---- ------- - �7 p _ --•-- ----- Phone.-�1-?-�•��----'.Q7----- Contractor's Name 4' •±�.0----•------ = s Motel Other Installation will serve: Residence IS Apartment;House-[]—-B—Go --G—Trailer Court ❑ ❑ ❑ Number of living units:'__I____ Number of bedrooms :___7�!Number of baths'.__]--- Lot size -----�- _ �-- Water Supply: Public system El Community system ❑' Private^ Depth'to Water Table _3P- ft- I Character of soil to a depth of 3 feet: Sand ❑', Gravel ❑ Sandy Loom S Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made: (if yes,date_____ ',-_. -. -) No [�] New Construction: Yes [I No FHA VA: Yes No `TYPE OFY{NSTALLATION ANDS CIFiCAfIONS (No septic tank or cesspool permitted if public sewer is available-within-200 feet;) ' Septic Tank: Distance from nearest well;__''_ --"______Distance from foundation______________.__.Material____________-_____.__._______.____..__________. r ',,t� No. of compartments-----------=--;;:---- �. • -� --------- -=--- 9 p• --•---- -. ❑ ------Size Liquid de th--------------------------Capacity----------------------• W Disposal Field: Distance from nearest well., 57�__._Distance from foundation----- ,_-:----Distance to nearest lot line..__ .t fq cQ Number of lines---------------)____--------------Length of each line--------f_B,C•_`___--......Width of french---------- -----------•-- Type of filter material __5_`ZAC-1L-___Depth of filter material-------1_14'''__`-----Total length---------------ICU)----------------- Seepage Pit: Distance-to nearest well----------------------Distance from foundation___________________Distance to nearest lot Iine----------------- ❑ Number of pits Lining material------------- --- ----Size: Diameter----------------------.Depth----------------------- --------- Cesspool: Distance frm nearest well__---_-------- Depth from foundation--------------------Lining material-__.___-._..___--_-._____----_------ ❑ Size- Diameterp -- ------Liquid Capacity----- ----------•---------gals. : -nearest-building ---------------------- ---------- Privy: - -- Privy: Distancefrom nearest well -------------------------- --.:Distance from r' ------------------- ❑ Distance to nearest lot line--.-.---- --------------- a t � t A cribe:_- CGL °" ��' :---- Remodeling and/or repairing (des � = 9 ------ -•--------•----- -----4--------------------- ---------------------------------•------------- -------------- ------------------------------------- -------- ---------------------- ------ _ I hereby certify that 1 have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and„regulations,of the San Joaquin Local Health District. --.---- �wner and/or Contractor) Si ned C�'ti''`'`4--------------- { g ) Z -_ .� n (T . � U ---- ---- :- r --------- --- ---------- _ - Y -----:. (Plot plan;showing size of lot, location of,system in relation to wells, buildings, etc.,.can be placed on reverse side).. t f FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED=BY ----- _ . I------------ ------ ------- DATE-----7n------ ---------------------------- REVIEWEDB.Yf------------------------------------- -------------- ------ DATE BUILDING/PERMIT ISSUED--------------- ----------------------------------------------------------------------- ------- DATE------------------------------------------ ------------------ Alterations and/or recommendations:---=---------------------- - ------------------------------------------------------------------------------ --••----------•- ----------- -y ------•-------- - --- --- ---•--------- -----------------------i-----------•------ r t ------------------------------------------------------ --------------- --------------- I FINAL INSPECTI� Q_ Date........ --------- r; SAN JOAQUIN LOCAL,HEALTH DISTRICT 1601 E.Ma=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63.F.P.=-