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- ` C) It — 1 1 ",\ -�� Vj • ` Permit No ---�-�� , APPLICATION FOR SANITATION PERMIT d (Complete in Duplicate) Date Issue1 �U work herein described- her to construct and install the Application is her y made to the San Joaquin Local OHden8tnceDiNoG 544r a p This application is made in Compliance with County •------ ` ca(: L� a Phone-,F ------- V JOB ADDRESS AND LOCATION.,_ -- 7 --- -- /� !'. ---- Owner's Name----------- - ----------- -- _ �. one . Address---•-•---------•--------•--••- Phone _ Other ❑ --- ------ Motel Contractor's Name----------- -" - Commercial ❑ Trailer Court ❑ ".Apartment House ❑ --__-_ --- installation will serve: Residence p Lot size __,5-" ----------- Number of living units: _�-- Number of bedrooms .-�- Number of baths . �- R Private ❑ Depth to Water Table-------- ft- and an :'�. �onimunit system ❑ 0� •�.rx` I Public system Y Y Clay Loam ❑ Clay ❑ Adobe p ❑ 1 - ,R Water SuPe y: . Gravel ❑ Sandy Loam❑ Y Character of soil to a depth of 3 feet: Sand ❑ ew Construction: Yes �o ❑ 4 Application Made: Yes ❑ No Previous App' TYPE OF INSTALLATION AND SPECIFICATIONS: M1 (No septic tank or cesspool permitted if public sewer is available within 200 feet-- Material________________ - Distance from nearest well" _ ------ stance from foundation__________________ _ 1 S3��. Size Liquid depth---------- -- ,----- Capacity.__ 0 No. of compartments-.___-_._-_. .- � istance from nearest wellDlstance from foundation__-�-��---�--- -Distance to nearest lot line-"_ --�------- D Width of trench------ --- ---------- ----"-•--• Disposal F'el = ---- - -.-Len th of each line-----�-v------�i--------Total length----.�r-- ----------------------- I �--------------- ----�--� Number os lines------- ............ g Type of filter material-4 . Depth af`filter material----/-- tin---�--�•-- --------------- ----- .Distance to nearest well"------�--------- ----Distance from foundation-------------------.Distance to nearest lot ine__.""-------- -- Dep Seepage Pit: Number of pits--------------------- Lining material-----------------------Size: Diameter______--•-------------- ❑ - � gals. Liquid Capacity--------------------------- Distance from nearest well_________________Distance from foundation_________------------------------Lining ma#aria__;"------------------- Distance ------ "---- - ---------------- Cesspool: ---.De thew �---- - ---------- Size: Diameter------------------------ building - - ❑ -----------------------Dns#ante from nearest _"- ---------:--- from nearest well_---------- ---- ----- . Privy: - , ❑ Distance:to nearest lot line._._-- --------------------- - - ---- ,�a.•�,ry_�'-1.-----------"--•----------•----•--- Remodeling and/or repairing (describe)-------------- ----------------- -----------•---•----•------- ---.--- - ------------------------ --__._ ------- -------------------- -- ------- - --•---�- --"---""-"""---•-----�"-- -�-_ -•--• -• Inca+ion and that the work will be done in accordance with San Joaquin County .- 1 hereby certify tha+ I have prepared this app ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ( caner end/or Contractor] - ---- --- ----- ------------ S's ned •------- - (Title)------ ( 9 } - ------ -- By. a___ ---,.__.___ etc., can be placed on reverse side). [Plot plan, showing size of lot, location of system in relation to wells, buildings, FOR DEPARTMENT USE ONLY DATE------------- ----F 3'--------------------------- 1 - _ DATE------------ -----•---•- ----"---------------------------- APPLICATION ACCEPTED BY----- --- "----- --- ------ - - - -- ----- --- ----- ------------------------- ------------------------------------------------ REVIEWEDBY.------"-------------------- DATE_-------------------------------------------- --------------- BUILDNG --------- ----------- -- BUILDWG PERMIT ISSUED_- -------------------- Altera+ions and/or recommendations:------------------ ------------------• ------------------------------------- - ----------------------------- ------ ----------------------------- -- - --- Date-- - -- -------�--- -/- --- ------ - �- - FINAL INSPECTION BY:_:-- -------- - { SAN JOAQUI N LOCAL HEALTH DISTRICT 814 North "C' Street { 132 Sycamore Street 30D West Oat Street Tracy. California 130 South American Street Lodi California Manteca, California v Stockton, California cc _0-9M 10-52 Revised W-2100