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APPLICATION FOR SANITATION PERMIT Permit No. l (Complete in Duplicate) Date Issued ---- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here's described. This application is made in compliance with County Ordinan 544. �I"I , i - -- LOCAT ON___ ------ JOB ADDRESS A /Cl - Phone ------•---- ---------_ Owner s Name------ Address----_---------------- � - _ rrac ------------------------•--- Phone*--. = Contractor's Name - ------ ` ' Commercial Trailer Court ❑ Motel [I Other El Installa+ion will serve: Residence Apartment Nouse ❑ Cial ❑ l Number of living units: __1---- Number of bedrooms "" Number of ba}hs ,_t of size __� ---••, �- Water Supply: Public system F-1Community system ❑ Private ep to Water Table elf+. Character of soil to a depth of 3 f"+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑i No New Construction: Yes &_00_0 J' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ a f i Distance from foundation__._:__ r_Material_____ 1'�` Septi Tank: Distance from nearest welL_:_ ._ i Capacity--/ Oro-"-0_ iquid depth-----r1-..-L------- No. of compartments- - --------.-- L E I - 14 ,--- line . . Disposal.Field: Distance from nearest well_ -."Distance from foundation__ -- .t Distance to nearest lot .__..____._.. Width of trench---�-- --------------------- . Number of lines_-____---f.._. � _�-- -_-Length of.each line________°,��------.- -- ----De Depth of filter material----- -- ---'-Total length------- "u `-•-------- ---- � Type or filter materiaL:__I_..l_-- -.-- p �I ___.Distance to nearest lot line__________ --------- __._Distance m fou dation_.___.`___ _ Seepage Pit: Distance to nearest well_. r Sixe: Diameter _____________De th__-_ .------�=---------- I Number of pits---.____/_.__"_-"----Lining material____ p Cesspool: Distance from nearest well-----------------Distance from foundation------------.------ Lining material____-.______--______-_-_---_-_______- � ❑ Size: Diameter------------------------------ - -----Depth----------------------------------------------------Liuid Capacity •---•--gals. l� Privy: Distance from nearest well--------------------------------------- ------ ----------------------------------------------- ---Distance from nearest building---------------------------------------- , ------------ i ❑ Distance to nearest lot ine___-____.___:---------------,--.-.-- I . ----------------- ---------------- 9 ------------------------------------ Remodeling and/or repairing (desk ribe):".______________-_. f --"--------- ----•------•-------------------------------•----•--------------------------- ----------------------- -------------------•-------------------------------------------------------------- his•a application and that the work will be done in a ---------------------------------------- l pp ccordance with San Joaquin County I hereby certify that ! have prepay d t ordinances, Stat a d rule nd egul of he Sa oaquin Local Health District, a -------------------------- d/or Owner a d/or Contractorlo, {Signe ------- • -- ----- --- -� - --(Title)___ -- - By''""""o buildings, etc., can be placed on reverse-si e). (Plot plan, showing size of lot, location of system in relation +o wells, FOR DEPARTMENT USE ONLY DATE-- r\PPUCATION ACCEPTED BY--------------------------- DATE--------- REVIEWEDBY------------------ -----------' -------- ---- ----------------- BUILDING PERMIT ISSUED___"____ ---'--------------- ------------------------------- Alterations and/or recommendations---------------_-----_----- -- ------------------- -------------- -1`� -------------` ' -- ._. •---- _------ ----- - 'may .-... ----- - -- - ,tj - - ------------ ---- -- ---- i FINAL INSPECTION BY� ._-- ---------------------------- Date.-.. - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Traey, California 1 Stockton, California Lodi, California ES-4^-7M 145446{,1'}NQ OQ 12-54 ---