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FOR.OFFI USE: -� ��1------; "� Permit No. --•--••---;- ••--- APPLICATION FOR SANITATION PERMIT _"- (Complete in Duplicate) Date Issued � �� This Permit Expires 1 Year'From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t co sfi> n� install the r^+ he e' de e,dy This application is made in compliance with County Ordinance No. 549-.AJC' "_�"" __- ---W" """..I�-A." 1-------------` ------- UJ--��-•---••_ •------- ------------••_-.-... JOB ADDRESS ND�01 r !! I ) PhonL Owners Name..---_-- ... ---- - ---- •-- -•- ---- _ Address-------------------- --------------- -------[-�--------• -------------------• P `� { Phone Contractor's Name.._"-. "' � ------ - - - � Motel Other ❑ Installation will serve: Residence $( Apartment House ❑ Commercial ❑ Trailer Court ❑ �❑ Number of living units: j---- Number of bedrooms - -" Number baths .-/""_ Lot size __-.""" --"".rte-- -------- Public system El Community system ElPriva}e epth To Water Table ._40t. Water Supply: Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hard an Previous Application Made: (If yes!date--------------------) No ❑ New Construction: Yes ElNo �HA/VA: Yes ❑ No [I e . TYP F INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V* - Distance from nearest well-----------------Distance from foundation---.-_-_.----_----.Material..-----.----------------•----•------•• No. of compartments----------------- -------Size---••-•-..----------------------Liquid depth---------------------- --Capacity-- ._""".Distance to nearest lot line__--_- © r --e Distance from nea est well__ "" _. _...-Distance from foundation____. ""Number of lines""-._____ " "-- Length of each line".�- ---�-- ••Width of trench."""_. ��C-� De th of filter mate .- Total length---------------------•------.•Type of filter mater P t r F Seepage Pit: Distance to Weare twell"-�.QQ"."-. "_Distance m f undatio ""_.! �•---Distance to nearest lot line".__ Linin mafienal_"" "" Size: Diameter- Depth-""".� "f.""". ""- Number of pits---- --------------- 9 Cesspool: Distance fsom�nearest well-----------------Distance from ndation.-.."."---_-" -"_".Lining material..--.-...---.----_-.--..------_"_ls a Depth----------------------------- ----------------------Liquid Capacity gals. i ❑ Size: Diameter----- ---------------------------- - Privy: Qistance from well------------- ----------------------------------Distance from nearest building----.------_----------------- -------•-- \ ❑ Distance to nearest lot line----------------- -------------------------------------------------------- -- - ----•---- t--------------•--------------••------ ------------•-- ----------- Remodeling and/or repairing ibe�:"""-- - -- -- ----------• --------- •-----•-_ i ---------- -- -- ---- ---------•-- - --- ---------------•- i -------------------------------- ------ - ----------------------------------------------------------- hereby certif the repared this application and that th ork be done Vaccorante with San oagwn oun y ordinances, =ws, a rule and regu s of the San Joaqui ocal ealt istrict(Sign --- ----- • -- (�r Contractor) ----- - - I Y:------------•----------------------------------•••-- - -- --------- (Plot plan, showing size of lot, location of system in re! on to wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _.k."_ --•---- -------- -- ------------- ------------- DATE._?__ "s- - .------------- APPLICATION ACCEPTED BY . BUILDING PERMIT ISSUED---------• - - -----•-----•-----•�-----•-----------•-----..._ DATE REVIEWED BY------•-- - ----------------•-------------------------- -----------•-------- � ------ - ---------._ DATE----------------•----•---- •----------------------- ------------------------------------ , --- Alterations and/ recom end'ations:."""- L 7 ..--------- == -. Z--_ A1X_ - <-%------------------- -----------------------------------------------------------------------------••----- ------------- ---------{------------ - ---------------- FINAL INSPECTION BY:.. "------- Date.--------- ----------•-----•----•---•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California I ES 9 REVISED 8-59 2M 5-62 ATLAS