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f FOR SANITATION PERMIT Permit No. ..._.._ . � APPLICATION 7 � S-- i (Complete in Duplicate) Date Issued r ---- - -� Application is hereby,made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. AJP 4?--------- -JOB ADDRESS AND LOCATION_______________v ? (j - - �--------------------- - ---- Phone------------------------------------ Owner's ----- ------------•---- -------- - Owner s Name---•---•----•------•--- -----• ---• Address-------------------------------•-------------------------------------- .... ---------• -------------------------------------------------------- - --- Phone----------------------------------- Contractor's Name---------------------------------------- --• -- - -- - � Motel Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ --- ------- -- --- -- Number of living units: ___/___ Number of bedrooms ._ �.. Number of baths ____.-- Lot size ______________�� - �- Water Supply: Public system ❑ Community system _❑ Prete, ep .tQ Water Table __.____. f#. Character of soil,to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClaylLoam ❑ Clay ❑ Adobe r pan ❑ a Previous Application Made: Yes 0 Noew Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspools permifted if public sewer is available within 200 feet.) I D_. Material----- . -- Septic Tank: Di from nearest well_ ______�.3.__;Distan P. from-foundation _.. No. of compaftments_______�`- Size q de . h --- �_apltfy_ well___ ___Distance from foundation_-4:0----.%Distance to nearest lot line_,, ----- Disposal Field: Distance from:nearest ��,��!idth of trench._ Len th of each line_-' -"T'�'" - -_ - Number of lines___________ __ 9 t Total length__----- - -------=--- - - ` • }h of filter material__ ._ _ 7f -.- - �� Type of filter material r,I -D�p - >�--,-- Seepage Pit: Dis}ante to nearest well_______________ y--Distance from•foundation.........-----------Distance to nearest lot ;ine-------------- e 1:1 ` -.» - _. " 'Lining material A= 5rze: Diameter------------------------Depth--------------------------------- Number 1 1 of pits--------- -------- r Cesspool: Distance from nearest well -Distance from foundation___________________ Lining material-------------------------_____.__---_ ❑ -------Depth__!-' -Liquid Capacity------------ gals. Size: Diameter----- ----------- -------- ------- Y---------------Distance from nearest building--------------------------------------- Privy: Distance from nearest well.-------�.---------------------- i Distance to nearest lot line------�--�'_}-----:=----- '"` _- ----•--•----•------------------------------------•-------------- Remodeling and/or repairing (describe)_---------____________--- £ ,. --------- ------------------------------------------•7 -----•-------------- ___-____.-_fi�_-_•_____________________________________________________________ ----------------------_-------- ---------------.---------------- _ ____ ________________________ _ ________ _ _ I here_ by_ __certify that I have prepared Phis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. /-,/ _\ (Signed}�----- •- --- ------nz� �---- �� -�'--------- ------------ -- �----------- ----------- - -------------------- -_____._._-__(Owner and/or Contractor) 11 '71 ' le iBy:-----------------_-=......----------- ------------ -------------------------------------------.---------------------- (Plot plan, showing size'of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR,DEPARTMENTvUSEONLY t ' APPLICATION ACCEPTED BY--- ---------------------- ---- --c- - 1- ---- -------------------------- -------- -- PATE '~ '' -' 3•--- ------------------- REVIEWED BY-- ------------------------------------- ----------------------- ---------- -------------- -------------- ----------- --• DATE-------------------•----------------•------------------- BUILDING PERMIT ISSUED----------�--------------------------------------------- ------------ ----------------------------1. DATE---------------------------------------------------- - -- -- ` ------------------------ -----------------•------------ -•- --------------------------------------- Alterations and/or recommendati s:-.____----------------- -------------------------- `= ----- -------------------- ---•--....__...--------- ----------•-----------------------------------•------------------ • �-- - - - --------------------------------------------------- ---------------------------------------------------- Date - ----------------------------- FINAL INSPECTION BY: - Date ------------ -------y------` i SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street [30 South American Street Trac California Stockton. California Lodi, California Manteca, California y r-S-9-2M 10-52 Revised W-2100