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} APPLICATION FOR SANITATION PERMIT Permit No. -1.2�� S-• (Complete in Duplicate) Date Issued _�!�'-�-------�- 111 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Districfi for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION_ ---- ----- - Phone ------------- --- Owner's Name------- _ __ ------ -------•-----------------------•------------------ Address--------- ------- Phone---------------------------------- Contractor's Name________________ _ _ _ _ _ _____ ------------------------------------------------------- - " � � Motel Other ❑ Installation will serve: Residence [/Apartment House ❑ Commercial ❑ Trailer Courfi ❑ ❑ Number f aths _e_ Lot s+ze - Number of living units: __I-- Number of bedr ------------------------------ ooms _ - #t tem Community system ❑ Private ;"Er0.000DeFtb to Water TableWater Supply: Public sys ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑o Y FHA/VA: Yes ❑ No Bim. Previous Application Made: Yes ❑ :No New Construction, Yes ❑ �, TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public se er is available within 200 feet.] n �� Mat r al._&-6 -- -- Septic T Distance from nearest wP,lj fe' Distance from foundation_-____ __ -�� Cigwd depth-_ ---- ---- -- p No. of compartments_- -- "- _=- "` -Size- Distance to nearest IS,t line.___ - ;'-------------- Disposal Fi Id: Distance from �erest� well- �____._Distance from foundation-`---IQ_�-otal hleon trench nc� ------------ a •---- Number of line's__.___.----r--- . ---- - _Length of each l ine.,7 -. IQf�- De Depth of filter matenaL.-. ------- g Type of filter material/ P '. �. 3 A �. __ 4 Seepage Pit: Distance to nearest-vwell_____________________"Distance from foundatiosi�"'-----_---==.Distance to nearest;`lot�l;he�,�;_------,:='" Linin material e - Size: Diameter--------------- -------Depth-------------------------------- ❑ Number of pits------------- g ; Cesspool: Distance from nearest well_________________Distance from foundation.==--------- Liquid, Capacity_._____.________-____.__.___gals. ❑ Size: Diameter nearest well Depth ; " - Diisfti e from .nearest 6uiN n9------------- ---------------------------- x Distance from -- -------------- ----- : Privy: .e h-:--------------------- -- ------- : -- F ❑ Distance to nearest loft line___----------------------- Iv ----------------- 1 - ---- 1 Remodeling and/or pairing (describe:-----A-- "' ---- ------------•-------•---------------- • ---• - --- '- i�------ � f ' - - ----- ------- --- - ---•------pP---- - -- ! hereby certify that I have kre aced this application and that the work will be done in accordance with San Joaquin County I?, P ordinances, State laws, and rules end r Mations of the an Joaquin Local Health +str+ . Contractvrl --------------------------- ------- (Signed) ----------- ------------------------- - - • - [Title] - - - - --- - ------ - - ---------- --------------- --------------------------------- --- = (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be,placed on reverse side). S FOR PARTMENT USE ONLY �-' - APPLICATION ACCEPTED BY------- ---- - - -- - - ----- - ------------------------------------------ - DATE---- ----��'-- --------- -- ---�-p------------------ APPLICATION -------- ------ DATE_ ------ REVIEWED BY - ` `= t'` ------------------ --------------------------------------- DATE '` BUILDING PERMIT ISSUED---------------------------- _ :+ i,` .. = ---------- . Alterati ns and/or recommendations:.______._____________________}_ ---------- --- - 1 r+ -----;------------- -- ------------- � v-- ------------- } — # A� ' •, Date---- -- --- ------�� -------------- --------------------------------- FINAL INSPECTION=;BY---------- ------- �c-- i •�1 v SAN JOAQUIN,LOCAL HEALTH'DISTRICT, 132 5y am a 5#real 814 North "C" Street 130 South American Street � P 300 Wast Oak Street Tracy, California Stockton, California Lodi, California Manteca California E5.9-2M R.Vised 0-'59 F.P-CO. -