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A}��71,0\"-' APPLICATION FOR SANITATION PERMIT Permit No. _Z1�n3......�-/- Q _ (� (Complete in Duplicate) — � l P Date Issued --- A Applica#ion 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. J4 ADDRESS AND CATION J -"-`-�' ��-- X' ---C- -- ----67_ - ----- ---- - �� Owner's Name - Phone.----------------------------------- Address-------------------------------•-------L5_4wj C'-_/----------------------------------------- ------------------------------------------------------------------------------------------•----------- Contractor's blame-------- P i Ph n---------------- ---------------- Ins+allation will serve: Re ce Z A artment House Commercial Trailer Court Mo#el O#her��QQqq Number of living units: !---- Number of bedrooms __ Number of baths -�- Lot size ----------4 Water Supply: Public system ❑ Community system ❑ Private $4--Depth to Water Table rr7_oft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Mede: Yes ❑ No SZ New Construction: YesFlo ❑ FHA/VA: Yes ❑ Nd'� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well_c6_f__Distance from foundation__._/___.Mate 6a No. -- ,� p ,lam�- /�4 Li uicl de th----�� !� m No. of com artments_ --------------Size-Size-/,? ------ - - q p. -----------------Capac:#y-��V Disposal Feld: Distance from nears well _-6__Q----Distance from found __� ation_ 0---_.__.Distance to nearest lot line/_ Number of lines_____ __ _________ _____Len th of each line______ _ �- Width of trench_____a_ _____ g - Z., ��J) --- Type of filter material- ._1� _ __ _ _ X____Depth of filter material____ __________.___Total length______ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.____________------__..___________. ❑ Size: Diameter--------------------------------------Depth---------------------------- -----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------- ______r -----------------Distance from nearest building_________-__________________------_____. -Remg❑ Distance to nearest lot lire--------- - - ------------------------•--------------_----------------------------------------------------- RK e mg e 1,i,n elin and/or repairi g describ :---------L ._ _. -__ -------- - - -- -� -------:-- I hereby certify that I have prepared-+his application and that the work will-be done in accordance with San Joaquin ounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' __________,_________.___--- Owner and/or Contractor (signed] - -- - -- By:-- -------------------------------- -------------------- -------------------------------------------------------------------------(Title)------------------- ----- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------ -- - DATE--- ---- BY--------------------------------------- - �-- ------------- --- - ----- - --- -- ------ - - -------------------- ---. DATE- �- --� - ----------------•---------------------- BUILDINGPERMIT ISSUED----------------- �_--- •-- ---------- ------------------------------------------ DATE--------------------•---------------------------------------- Alte lens d/or r ommendati s--- - ------------ -`--__-- ------- -- -----__--•- ----_- -- -1 ---�--(� ---- ----------------- ------------------------------------- ------------------------------•---•-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------- 1/ Date -- / . / ---------------------------- - FINAL INSPECTION BY._-- �-- - --- ------------- - - ---------------------- - SAN JOAQUIN 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---9-2M , Revisea 1-57 F.P.Co.