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FOR OFFICE USE: L "Y ----------------- --------------------------------------- APPLICATION FOR SANITATION PERMITPermit ----------------------------- -------- -------- -------- [Complete in Duplicate) pate Issued .. /a- �5-^�s This Permit Expires 1 Year From Date Issued - - Application is+ereby 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. tZ.�i�Cy4,�ry,�-.tet - � ��,,,�-- ..---'� -----�u-_.�-`•'�-� JOB ADDRESS LOCATr,OCiV r -s: x - ---- -------- ------------ ------ -----_------ Phone Owners Name_-- _ l Address-------- - =_ f • - . :- ---•--- one c+ ti - .y,.. -- - --- Contractor s Name_------_-- -- ----------------- - ------- --------- e '" � A� Motel ❑ Other [� Installation will serve: ,Residence ❑ Apartment House ❑ Commercial ❑ -'Trailer Court ❑ '_ ize ------�-��-- --• - '- ----- __ ---------------- Number'of living units: --- Number of bedrooms _-..---_ umber of baths ___-- Lot s Water Supply: Public:syste ❑ Community system ❑ privateepth to Water Table .-._-... ft. k Character of soil to a depth 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hard No E]Previous Application Made: {if yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes E] TYPE aOF INSTALLATION AND SPECIFICATI NS: [No septic tank or cesspool permitted if u6lic sewer is available within 200-feet.) ' lll�� I 1 Septic Tank: Distance from nearest well.t`...'.'S�___=Distance from foundation...... .....:._._.Materia-....__... _-,.._---___________..- -----. No. of compartments-.._.....��.--.-. Size. -!/ Liquid depth----_V-2-----------.Capacity lJ s a__'-.......Distance to nearest lot lines__ -.-_.. Disposal ield: Distance from nearest well-•�..--------Distance from foundation--- of r Length each line------1-no � -- Total length of trench-------------- ------ ! Number of lines...... ....... .. g Type of.filter,material-_.- ----------Depth of filter material_---_.-j. Total length-__.....� G_______ ________ � Seepa Pit:• Distance to nearest well--..�_ __-f-Distance from foundation....................Dt3alce fio nearestt _. --- (� a Number of pits__-....`y------Lining material-___ _. S P m �1 fro nearest well.._._____--____-Distance from foundat onpiameter Lining mat D al}..------------ ---- ----- ----- Cesspool. Distance f __gals, ❑ L Liquid Capacity------------•--------- Size: Diameter------•-• --------- --------- -.Depth-------- ---------- --------= --------- - .. 9 -�.. `r r Priv Distance froml.nearest well....................................._...-___...Distance from nearest building Distance to nearest lot ` line- ---------- -------- --------- ---------------------------------------- --------------------------------- --------•--------------•------------------------------------ Remodeling and/or rePairjn9 describe): - -- t _ ----------------------------- f -------- ---------------- --•--- ------------------ I---------------------------------------------- --------------------------- ------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staf wS, and rules and regulations•of the San Joaquin Local Health District. _--.- - (Givinarnsrid/or Contractor) (signed)------ - �.: `(Titlep--- ------- --- - - -- .. -- ------- ey:. - � _ ------ -- -- ------------------------- .� �. (Plot plan, ing size of lot, location of sys em in relation to.wells, 6uildings, etc., can 6e laced on reverse side). i € A FOR DEPARTMENT USE ONLY T . . ' ^'"ice`�' ------------------- ------•---- -_- DATE APPLICATION ACCEP�h�.---- .o- --- ,. DATE- P REVIEWEDBY-- ---------- ------------- -------- --------------------------------------------------- - BUILDING PERMIT ISSUED-------------------------------- = - DATE------------------------------------------------------------- Alterations and/or recor�mendations:__..-..._._______________.-.------------:----- ----------•-------------- ----r--- -. � .. Date -- --- --- ----- -- --------------- --------- FINAL INSPECTION BY----- -- -- --- -- ^'� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 s.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-'63 F•P•CD. •a t