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APPLICATION FOR SANITATION PERMIT Permit No. (Cp te in Duplicate) Issued omplete Date al Health District for a permit to copstruct and in all The h d c 'bed. 0 the San Joaquin Loc VL Application is hereby made t Ordinance No, 549, ",,j -2-50 e.in compliance-with County This application is.mad ----- ----- ----------------- ----- JOB ADDRESS AND LOCATION----- --- - ---------------I f Ph e�--------------------- ----------- ---- --------- Owner's Name ---------------------------------- ---J4 --- --------------------------- -------- �-------------- Address----------- - -- ------------- •--------- --------- ---- Phone--------------- --------------- ------------------- -------------- -------- --- ------- - Contractor's Name-- - - ------- ------------------------------------Commercial Trailer Court El Motel 11, Other Installation will serve: Residence [] Apartment House 0 size Number of living units: -------- Number of bedrooms -------- umber of baths -------- Lot I e ft 2i Water Supply: Public system El Community system E] Private IV Depth to Wafer Tab Character of soil to a depth of 3 feet: Sand [I Gravel [I Sandy Loam [I Clay Loam 0 Clay Adobe[] Hardpan 0 Previous Application Made- Yes El No!P/ New Construction: Yes Yes [] No& TYPE OF INSTALLATION AND SPECT (CATIONS: 200 feet.) (No septic tank or'cesspool permitted if public sewer is available within Septic Distance from nearest well_-__-_______-_ Distance from foundation-------------------Material----------------------------------------------- Capacity---------------------- aA Liquid depth-------------------------- ize---------------------------- p ments-------------------- --- ine No. of Cbrnpart ----Distance from foundafion _�- ------Distance to nearest lot I ------ 411sposal Field Distance from nearest well ----------- ------------- ------------Lengfh of each line------ -- -----------Width of trench___ -- ---- Number of lines ----------Total length------- -----------------t Type of filter mate CekDepth of filter material----- Dist ce to nearest lo Distance from foundation___.___ -- -------------------- eepa e Pit: Distance to nearest well /Zepth------------ -- Number of pils_... ............. undation----------------_Lining material------------------------------------- cesspool. Distance from nearest weq-----------------Distance96 ---------gals. 01 Size: Diameter---------- Depth------------------------------ ------- -------------Liquid Capacity------------------- ElDistance.-f rn_nearesf_b�uilcliriq�----------------------------------- Privy,_ Distance from nearest well------------------------------------------------- -------------------------------------- ------------------------------------- Distance to nearest lot line----------------------------------------------------- -------------- mo eling a dor re airing 3cribe) air n Remo eling a d/or re c ------------- ----------------- --------------------- -- -- --- ------ -- --------------------------------------------- .. ........... ..... .. . ------------------------------------------------------------------------------------------------------- --- ----------I--- ------------------------ - -- -------------------------------------------------------------------------I----------------------- --------------------------------------------------------------- ------- ---------------------------- -----------------I herebi certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y , ordinances, St laws, and rules;and�?reulaflons of the San Joaquin Local Health District. do— ______---{Owner and/or Contractor) (Signed)-------------------- ---- ---------------- ............... .......... --------------------------- ------------ ------------ --------------------------------------------------- ---------------(Title) By:------- ------------- (Plot plan, showing size of --lot, locafto-------------------- n of system in relation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY DATE---------- ---------------------------- ----------------- APPLICATION ACCEPTED BY---------------------------------- ----------------- --------------------- DATE------- /------------------ ------------------------- ------------- REVIEWEDBY--------•-------------------------------------------------------- ------------------ DATE------------------------------------------------------- BUILDING PERMIT ISSUED_____________________________ __ --- --- ------------------- ------------------ ------------------------------------------------ --------------------- -----------...... Alterations and/or recommendations_________ ---- ------- - ------------------ ------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- ------------------- --------------------------_---------------------------- --------------------- ----------------------------------------I--------------------------------------------------------------- ----------------- ---------- -------- ------------------------------- -------------- ----------------- -------------------------------------- -------------------------------------------- ----------------------------------------- -----I ----- ------- ------------------ ------------ -------------- -------- - - ---------I----------------------------------- ------------------------------------------------------------------------------ Date----------------- ------------- FINAL INSPECTION BY:__-__-_-.____-___ ---t --�d-------------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT $14 North "C" Street 130 South American Street 3o0 West Oak Street 132 Sycamore Street Tracy. California S+ockton, California Lodi, California Manteca, California ES-1-2M - Peviseci 1.57 F.P.CO.