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y POR OFFICE USE: I -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - -------------------------------------------------- - - - ---------------------------------------------- (Complete in Duplicate) Date Issued .-f-"_�-�---�P _ . --------------------------------------- ---""__-" -.._- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Loca4 Health District for a permit to construct and 'snstal! the ©,7�7LY-Z r`ib/ed. , This application is made in compliance with County Ordinance No. 549:�� ©ML �-I JOB ADDRESS AND LOCATIONIla--- Phone -------- -- ------ ' - ------------•--------•-------- Owner's Name--- -#--�-1------- -------•- .. ---------------------------------- -------- --------------------------------- �"� Address. �'" f -- ,g9 = =M Phone Contractor's Name--• V 's ,�o.. -- Trailer Court Motel ❑ Other ❑ Installation will serve: Residence [Apartment House ❑ Commercial ❑ ❑ 'Leg Number of living units: _1---_ Number of bedrooms .- Number of baths I�Lot size ._.__.__ g -• --•-------------- Water Supply: Public system [I Community system ❑ Private �epth to Water Table ------ - ft. I Adobe Hardpan, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay 'oam ❑ Clay ❑ ❑ `-_ FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date-`.----- -- -) No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: it (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Septic Tank: Distance from nearest well-----------------Distance from foundation_-----�------------Material-----------.------------------------------------ - ti i u ❑ No. of compartments-- -------- -..........Size---------------------------------Liquid�de- q i p•th------------- -----------Capacity-_ Disposal Field: Distance from nearest well. " -------�-Distance from foundation_.--"_I!-"-----"_".Distance to nearest lot line________________" ❑ Number of lines---"--------------------------=----Length of each line----------------- Width of trench. h1 Type of filter material------------------------Depth of filter material----.---- -------- -..Total length---------------------•----------- ------ ____._..Distance to nearest lot me__._.__.______._ Seeps Pit: Distance to nearest well_._._._ja0.-----Distance from foundation__.._ « f Number of pits..-.___/_.._____..--Lining 'material_.__,.-�_.___-.5ize: Diameter-- -_ 3.- -----Depth-...'"---------------------- 1 Cesspool: Distance from nearest well.-._--__-____._Distance from found stion._-._f�--------------Lining material_..-_-"------ ----------als. eo� ❑ 5ize: Diameter -------t--Depth-------------------------- --------- M Liquid Capacity g 1 Privy: Distance from nearest well---------------_---------------------------------Distance fr nearest building--------------------------- 01 ❑ Distance to nearest lot line--------------------- -----`---------I'-"""-"------ ----- ----- ------------------------ ----------------------- a . tl1 I _I: Remodeling and/or repairing (describe): - .I --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules and r g tions of the San Joaquin Local Health District. --�--------------------------- r and/or Contractor) (Signed)-------- ------ -----\ ---j------ ---- -- - ---- - - ---------- ---- ----- - -------- ---------- ---- - By: ---------- ,L1 -----------------------------=-- Title ---------------------------- --------------- .--- ---- ----- - (Plot plan, showing size of lot, location of system in rely ion to wells, buildings, etc.,Yuan be placed on reverse side). FOR DEPARTMENT USE ONLY jj q------- DATE-7- APPLICATION ACCEPTED BY. /t�'' r-vr�''= ` ... ---------Z------ --- ---------- ---------------- ------ ----------------------------------------------------------- -------- ------11 --- DATE------------------------------------------------------------ REVIEWED BY------------------ ------ ------ --------------------------------------- 1Y --------------------- BUILDING PERMIT ISSUED---------- ------------------------------------------------------------------- F Alterations and/or recommendations:---------- ------- ----------------------I'---------------------- ---------------------------••-----•-------- ------------- ---------------------------- ------------------------------------------------- - -------------------- ------------------------------------------------ -- ------- ---------------------------------------- ----------- -------- ---------- -------------- / FINAL INSPECTION BY:..-:-- --- 1 -- �'- ' �" ----- ---------- 'I SAN JOAQUIN LOCAL HEALTH DISTRICT ij 1601 E.ma:eltan Ave. 300 West Oak Street 124 Sycamor'Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. I