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Permit No. -� !y- -------- C�--�-°�' i APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date IssuedK!/--7-" --------- Application is hereby made to the q San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance: ith Count Ordinance No. 549. JOB ADDRESS AND:LOCATION-------------- ---�---/___ - ---XE---- - ----- - - - -"------------------------ --------------------•----- -- ��r+•�� Owners Name--------------- -- ---f�---'---- -------------------- Phone------------------------------------ Address-.. ------ -Address_.. -- � ------�------- } Phone------------------•-------•-------• Contractor's ame__________ ---- --+- ---- Commercial Trailer Court ❑ Motel ❑ Other Ej Installation will serve: Residence " Apartment House ❑ ❑ Number of living units: ___'__-_ umber of bedrooms _ ___ Number of baths _Ler Lot size .___ ------------ Private ❑ Depth to Table ________ ft. Water Supply: Public system [ Community system ❑ a Ad Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [IClay Loam ElCly ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes J4 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � f V_'..__------ _ _ ,Mat ial-------- -- •------------------ Septic Tank: Distance from nearest well----)__--Distance om fou dation______ _ - -- _ Liquid de th_"---__- _Capacity---------------------- to --Size------- q p. d. No. of compartments_.....-__ __._______- " � - •-- �} t I 5 __.D' to a to nearest lot Ii ._____-Distance from foundati n__ Disposal Field: Distance from neare t e Length of each line___ •• yii of trench.__--_.__ _ E Number of lines___..- - g Type of filter material____ . --�-a_ Depth of filter material---- -__--_.__Total length___-.-rest l - --� --- - i Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearesfi lot line_-_____--___ Nutanc of sts.'- Lining material-----------------------Size: Diameter-----------------------.Depth--------------------------------- ❑ I i P r Cesspool: Distance from nearest well________________Distance from foundation_________________.Lining materia__-________.------------- --"-- els. 1 Depanc - -----------------------Liquid CapacitY----------------------------g v ❑ Size: Diameter----------------------- -------------- Privy: Distance from nearest well_____________________'.-------------- Distance from nearest building--___________________________----___.__. ❑ Distance to nearest lot line________________________________ = -------------•-------- ---------------------------------------- --- ------------------ } I ' ------------•--- ------------ -------------------- Remode ing and or repairing (describe):____________________ -r�----_-----.--- I ----- - _ Yy;�; + ----------------------- I hereby certify-that I have re are this,application and that the wo,ac a work WheDdone n a+n accordance with San Joaquin County ordinances, State laws, and rules and regulations ;f the San Joaq (Signed) _t4 �. _.(Owner and/or Contractor) / ------ f {Sig ) 4 Tii --------------------------- ----------------- #e By---- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, a#c., can be placed on reverse side). t FOR DEPARTMENT USE ONLY = DATE-------- - APPLICATION ACCEPTED BY =, � DATE------- ! - ----------------- REVIEWED BY------------------------------------------------------------------ ---------- ' -------- -------------- DATE-- ------------------------------ --- --------------------- BUILDING PERMIT ISSUED-------------'---------------------"- ---------------------- Alterations and/or recommendations:----------------- -------- Date----- ` ' �� FINAL -INSPECTION' BY--- - --------- - ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street I 300 West Oak Street Tracy, California Stockton, California I Lodi, California Manteca, California ES-9-2M 10-52 Revised W-2100