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LFORCE USEPermit No. -_---•--" - APPLICATION FOR SANITATION PERMIT(Complete•in Duplicate)-- --- --- ---- ---- - Date IssuedThis Permit Ex firesate issuedis hereby made to the San Joaquin Local Health Di oc 5ffo9r a permit to construct and install the work herein described. . Applicatione with County Ordinance This application Is made in / w ------------------------------------------------ <.- -------o------------------------------------------------------- - ADDRESS AND LO ATION----- Phone--------------- ------------- -- --- ---------------------------------- Owners Name---------- _ - -------�------------------�----------- Address------------ --- one_ �g P Contractor's Name--"-_:_._ � (� "'"" Motel ❑ Other ❑ _,,,� artment House Cl Commercial ❑ Trailer Court ❑ Installation will serve: Residence L� �P -- +� -- -" Number of baths-�-- Lot size -�� Number of living units: __/--- Number of bedrooms Depth s Water Table ,� Private ❑ P q ardpan ❑ Water Supply: Pubtic system [Community system ❑ ❑ Clay Adobe(gam' A Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa n No '"HA�VA: Yes ❑ No m Previous Application Made: (if yes, No New Construction: Yes �' pP date_ } ��~ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material _._._.____"-------------------------- ------- t I Septs„Tank: �" Distance from nearest well-----------------Distance from foundatiLn-uid de th......... ... ... _ Capacifiy.____-._._._.�-,_-- \ �4��No. of compartments --------- Size q P f -, , _.__._.Distance to nearest lot line -- _--------• om nce ' length Disposal Field: r Distance from nearest well.---""' Denath of reach line atio .-- r line-. Width of trench_..__ . Number of lines __.__/- ` e 9h of filter �" Distance tonearesot lid+;- ---/ / Type of filter material , P / Z �' ..Dept'n_mr — Pit: Distance to nearest well... �"-"'-.- ---Distance fr °u aiZs°nDiameter.��--------- p s ..____Lining material_ DistanceNumber nearest well __.._.-"---.- --Distance from foundation,............" -- ..Lining material._._.."-------------- p Cesspool: el -------- Depth--------------- ------------- ---------------------Liquid Capacity --------- -------------gals. . ❑ Size: Diameter:-- --------- ' it Distance from neares+ building"_"------------------------------ ------ ' Privy: Distance from nearest well--- "----- ------ ----- ------ ----- ------ - ---------------------------- I❑ to nearest lot line----------------- ------------------------------------------- Distance ----------------------------------------- 1 g repairing ( scribe) ---------- ------- Remodelin and/or re air�n -------------- ----'�. ---------------------------------------------- a - of }hat I have ----------------- - •---------------- 1 ---------------- ------------------------------------------------------- ------- - I hereb ter y prepared this application and that the work will be done in accordance with San Joaquin County Y i ordinances. State,levrs„and rule};and regulations of.the San Joaquin Local Health District. �o Contractor .'� - r ...... - v _ ---- ----- ---- ------ ---------- (Signed) --------(Title ..- ----- ---- _�o buildings, etc., can be lace on reverse side). (Plot plan, showing size.of lot, location of sys+em i 4lation to wells, x - FOR-DEPARTMENT USE ONLY F DATE.------ '7.= w- ----------------- ... I ,,�F'LICATION ACCEPTED BY - ` = E)ATE - - REVIEWED BY - ------ t DATE --= BUILDING PERMIT ISSUED;---' -------------- - -------------------- Alterations and/or recommendations:--_._.._- ---------------- --------- ---------------- ------ - - -- ----- ------- ------ ------ ------ i ------------- ----------------------------- --------------- --------1_-___1 ------------- ------------ - ---- --------- - -- ------- `J1� �, Date._... �� G V ------- FINAL INSPECTION BY :------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West oak Street 124 Sycamore Street 205 West 9th street 16ol E.Hazelton Ave. Lod+,California Manteca,California Tracy,California I Stoekton,eanfornia E.H.9 2M 1-67 Vanquard Press