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APPLICATION FOR SANITATION PERMIT Permit No. _SZ .V.- �( (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordi nce No. 549. + -------------------- ------- JOB ADDRESS AND ATION!________ _ - Phone.--------------------- { Owner's Name------ _fj • Address----- ------ - ----=----- • r � --------- ---------- ---------- --------- ----------- -------- --- Phone.---------------------------- ---- Contractor's Name---- -- ------ Motel [I Other E]Installation will serve: Residence RP-'Apartment House El Commercial ❑ Trailer Court ❑ Number of living units: _ ___ Number ofbedrooms _ _ Number of baths -/,, Lot size -------------------------- Private Ar--Depth-t6 Water Table � ft_ Water Supply: Public systsm' ❑ 'Commun'-sty system ❑ �p Character of soil to a depth of 3 feet: Sand$❑ Gravel❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No F14 New Construction- Yes ❑ No E] FHA/VA: Yes L] No F3 TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) .. . .4 epti Tank: Distance from nearest well'______________Distance from foundation____-_________.____.Materia_____________________-..__________.-___..__.__. compartments-------.------------------Size--------------------- - Liquid depth_------------- ------ No-of = Capacity. t. { Disp 'al Field: Distance from nearest well________--------Distance from foundation-------.._:______.,Distance to nearest lot line____.:_._____._.. ---------------- Number of lines ---------------------Length of each line------------------------------Width of trench------------------- Type of filter.material---- -------------------Depth of filter material-----------------------Total length------------------------------------------- to Pit: Distance to nearest wel __ --? --Distance fr�m foun tion_� ----_.D sty�ce to nearest lot line_ ----Size: Diameter__- -_.Sj- Depth----- ~- ----------- Kimber -- -- Number of pits-----�--- ------j,Linrng material,/, - -- � Cesspool: Distance'from nearest well----------------- from foundation:.--_____..__- __.Lining material_________________________________ads. { ❑ -Liquid Capacity---------------------------- Size: Diameter--------------------------------------- Distance ----------•------------------------ Depth g Privy: Distance from nearest well------------------------------------------------Distance from nearest building___.--____.___--_------------------------ ❑ - - ------------------=-------------------•---------------- Distance to nearest lot line- ----------- --------- ----------------------- --------------------------------- 61 - - - - - --- ----•--•-----------------------•--------------•----=-------- � Remodeling and/or repairing (d�scribe)______________________� --------- --------------------- --------------------- ---------------------------•--------------•- - ------------------------------------------------------- I hereby certify that I h�ve,prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and-rules and re lations of the San Joaquin Local Health District, 1 -------------------I-----------------------(Owner and/or. Contractor) (Signed) - -- - ------- By--------------- --------------------------- �ofsystern --- ----- - 1--- ----------------------------------(Title)----------------------- ------------------------------------ (Plot plan, showing size of lot, loca n in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY i DATE_. APPLICATION ACCEPTED BY ----- --------------------------------------------------------------- REVIEWED BY ... DATE P ---------------------------------------•------------ BUILDING PERMIT ISSUED-------------- -•-------------------------------------------------- DATE-----�- -------- ----------------------------------- ------------------------------- Altera#ions and/or recommendations:___----------------------------•----- ----------- -•-•-•_-----•--.- _ ------ r -------- $ __ I �— __ ------------ -------- ----------------------- -- -'_- �s---- e ____ __-=_ ____ ----- -----• ----- -----4- FINAL INSPECTION BY:____:-_---- =- ------------------ Date---- ` �`-"� ------------ :------------------- + SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Traoy, California E5-9--2M Revises 1,57 FY CO.