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APPLICATION FOR SANITATION PERMIT Permit No. .... / 4 (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date_ Issued Application is hereby made to the San Joaquin Local Health District for a per into construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. wk JDB ADDRESS D LOCATI N... -------------------------------------------- Owner's -------Owner s Name____. W ---- -- _ .. _- . a h ----- ---- ` Address ">s -- --------- -- --------------- -------- Contractor's Name___--- " a s --- -----' -------------------------------------- Phone-----------------------_-------- Commercial Trailer Court Motel ❑ Other ❑ i., Installation will serve: Residence ❑ Apartment House ❑ ❑ Number of living units: _ _____ Number of bedrooms ________ Number of baths ___+__"Lot size ------ ----------------------- Water Supply: Public system ;9 Community system ❑ Private ❑ -Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loamx Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ •� Previous Application Made: Yes No ❑ New Construction: Yes ❑ NojX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet. Se ti Tank: Distance from nearest weli__ __ _.__Distan e fro foundation_ .-/_d_______.Material-__-_(I -, .-.l.� No. of compartments------.._�__.__..__-_Size �r _ r "_ ___Liquid depth_____U_ _.Ca otic h� 7r ---- P. y'"- ------ p Disposal Field: ( Distance from nearest well---------------_Distance from foundation--------------------Distance to nearest lot line----------------- �N ❑ Number of lines-------------------------------=---Length of each line------------------------------Width of trench----.-------- ----------.-------.-- Type of filter material-------------------------Depth of filter material---.-------------------Total length--------.--------: ,---.- ------------------- rn See . e Pit: Distance to nearest well---bn__"l____"-Distance from foun ationl 91.............Distance to nearest lot line__ Number of pits-----)--------R-----Lining material Size: Diameter_-q-I'�1-------.Depth---104-------------------- Cesspool: Distance from nearest well-----------------Distancfoundation...---------------- Lining material-------- ----------- ----•- \- ❑ Size: Diameter"-------------------------------------Depth--`------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ................"___.___.____----.------------Distance from. nearest building----------------------------------------- ❑ Distance to nearest lot line----------------- ---------------------------------------------------------------- --------------------------- ------------------------------ Remodeling and/or repairing (describe):-----. - --- --- -- -•----- -- ---- -- ' 7-:ew - N ---- ------------------ - h ------------------------=---------------------- I . -------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------;----------------------=------------------ I hereby certify that Fhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joa in Local Health District. i ------- (Signed) a y .± ---------------------- -- - -----{ wner and/or Contractor) -. __.. Octor { 9 )------ ----------------•-------------------- Titl )-------------------------------- BY• (Title) (Plot plan, showing size of lot, location of system in re! on to wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY. --------- DATE ' REVIEWEDBY.----------- --------- ------- ---------------------------------------------------------- -- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------- -----------------------------------------• DATE------------------------------------------------------------- i Alterations and/or recommendations---------------------- ------------------------------------------------------------------------------------------------------- i ------------------•-------------------------------------------------------------------------------------------------- --------------------- --------------------- - ----------------------- - ------------------ i FINAL INSPECTION il BYP m 4/_ SAN JOAQUN LOCAL HEALTH.DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised 6-'59 P.P.Ca.