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�. s�� APPLICATION FOR SANITATION PERMIT Permit No. (Com*�lets in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for'a permit to construct and install the work-Iherein described. This application is made in compliance with County Ordinance No. 549. 11 ---------- ii JOB LOCATiON----AJ-4- ��- JOB ADDRESS A V Phone------------------------------------ Owner Is -------- ------- - ----------------- 4-------- . . ........ ------------- ---------- ------- Addres Phone. Contractor's Name------- �j urf [I Motel F AA�- Installation will serve: Residence 0 Apartment House ❑ Commercial 0 Tra'll�rlr Other ev Number of living units: -------- Number of bedrooms -------- Number of bat----------- ot size --------------------------------- .4 r Table ft. Water Supply: Public system [Community system D Private E] Depth to Wate ii Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam 0 Clay Loam [I Clay 0 Adobe [Hardpan E] 7 Previous Application Made: Yes ❑ No [KNew Construction. Yes 2� No El FHA/VA: Yes ❑ No El;'; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if publi se er is available within 200 feet.) nearest welt ZZ iion--/��----------Material--- - --- ------------------ Septi T k: Distance from ------ Distance from founda .. i�e--a77a7-��datioln ----- quid, e p*--- -------- pacify--/---r�7�No. of compartments----- �7--------- --- - ----!5DisposalF�eld: Distance from nearest wellAZAistance from un .�-/ - Distance to neare�t lot line -----------Length of each line----------�2............Width of trench---I �- - ��f� of lines---------- ------------ h �3 _,, Type of filter materiaI----$-AC4---Dep6-of filter material----/9.........Total len ---AO----------Distance to nearest lot -------- Seepage,pif: Distance to nearest "-_Distance rouf Pn ---33 A/ D e p th -------------------- Number of pits------4 ' material -----------Size: Diameter ------------------- ---------------Lining Cesspool-, Distance from nearest well_________________Distance from foundation------------ -------Lining material------------------------------------ -------------- --Dista --Liquid Capacity-.--------------------------gals. ❑ Size: Diameter---------------------------------------Dept h-------------------------------------------------- 1! Distance from nearest building---------- --------------.------------ --- Privy: Distance from nearest well---------------------------- ----------------------------------- ❑ Distance to nearest lot line------- ------------------------------------------------------------------------------------------- Remodeling and'/or repairing (describe :---------'---------------------------------------------------------------------------------------------------------------!------I----------------------- ----------------and/or I--------------------------------------------------I---------------------- --------- ----------------- -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ------------------------- ---------------------------------------------------- -----------------------------------------------------:-- ------------------------------ ----- --------------------------------------------------------------------------ipplication and that +he work will be done in accordance with San Joaquin County I hereby certify that I have prepared'this i ordinances, S e laws, and rule and regulations o�ffhe�an Joaquin Local Health District. (Signec V Owner;and/or Contract . . ........ ..........................9------ Arl- - ----- --- ------------------- --- By:.- - --------- L - ----- --------- -------------------(Title) ---- ------- - reverse side). (riot plan, showing size of lot, location of system in n to wells, buildings, etc., can be placed on rev FOR DEPARTMENT USE ONLY ------------- --------------------------------- APPLICATION ACCEPTED BY - --------------------------------------- DATIE 'A,](A DATE---------;-----------------�l ---------- REVIEWEDBY------------------------------------------ ---- --I DATE-------------------------- --------------------------- BUILDING PERMIT ISSUED-------------------- --------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------7 -------------------------------------------------------------------Y---------------- ------------------------------------------------------------I-------------------------------------------------------- --- ---- - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i----------------------------------------------------------------------------------------------------- - - ------------------------------ -------------------------------------------------- ---------------------I------------- --------------------------------------- --------------------------I----------:1----------------------------------- ----------------------------- fDate --- - ------ ---------------------•----------------- FINAL INSPECTION BY:4 , 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 TraeY, California E5-9-2M Ravise6 1.57 F.PrCo-