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Permit APPLICATION N APPLICATION FOR SANITATION PERMIT �� ?► �``f1 (Complete in Duplicate) Date Issued /9 5 Application 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. `roo 2 - - ------- JOB ADDRESS AND LOCATION----- 1�--`� ne Owner's Name-------------------------- - e ------------------•------- ---- ------------------------------ -------- ----------•------- - �' •' .iAddress_.... _::_= ---------=' = .:: :- :4 - ' '' - ---------------------------------------------------------- Phone. + Contractor"s .Name=___- I} ---- 4 , . �u y Motel Other4K Installation will serve: Residence ❑ Apartment House ❑ �Commercial ❑ Trailer Court ❑ ❑ ,INuro' "I of living units: __--____ Number of bedrooms __ - Number of baths -------. Lot size -----L` -x-- -------------- ` Water Supply: Public system Community system Q, Private ❑ Depth to Water Table -------- ft. �1 ❑ y Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam Clay ❑ 1 New Construction: Yes Et No ❑ Previous Application Made: Yes ❑ No ` TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer R available within 200 feet.) ��, I ? v� eL Septic Tank: Distance from nearest well-------------__-Distance from foundation_--- 9-- Material--��---- _-W______------- --------------- No. of compartments--------------------------Size:_._ _ x-` '--Liquid depth--------4'4--_-_---;Capacity___-/ `.�5------,_ Disposal Field: Distance from nearest dwelell_-`D -----;=Wi nan of each line_ation----fid-- =--_--_W dthcofttrench est io- -----_-----_ (A Number ci Imes-- ----r -- ;-- - -----Leg 1 '1, �Q e tGf filter material------- ----Total length of filter material_ '-'"_ ' 4P �r— I t1 ' l - Seepage Pit: Distance to nearest well--,AV from foundation__.l�___-_ -__.Dsstance tonearestlori -�_-------- }� Number of pits_�-----------------Linin material__ �_----------Sizer- p Ces"s"pool: ` Distance from nearest well---____-_-----_Distance from foundation---_-.-__---�-.-__Lining�ater}„a!-----------------------______------ Li uid Ca acct gals. ❑ .� Size: Diameter----�---------- ----------------------Depth---------------------------- - q p Y Priv Distance from nearest well--__------------- ----_--.-_-___---_--- --------------...,-Distance from nearest building-------------s- --- F Privy: s ------------------------------------------------------------------- ❑ Distance to nearest lot line-------------------------------•-----•---- - --------- � s H;:M : ---_�: –------- i ---------------------------------------------------------------�;�repairing (descn e):--__________________ ��_ ��•_,_,,,, _ ------• --------------------------------•--------};------------------------ _------ ---------------------------------- --------- --- ----t---------•--- ----------------------------------•---- -- --------------- -------------------••-------------------- ------------- ----------------------------------- ------------------- ------ -------- ------ ---- ------- ----------j------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. ( i. �� _ wner and/or Contractor] (Signed)_-I�• - ----------------------- _ ---- ------------•--- ------------------LTi e)--------- ------------------------------ --- --- ----•---- --- - (Plot plan, showing size o lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --- DATE-- --- ---------------------------------- ------------------------ ------------- ------ DATE----------- ------------------- -- REVIEWED BY----- ---------•--------- -------- ------------------ ----------------------------- --------------------------- - --- -- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------- �---------------------..-- -. _ �'. = _== T - - ---- ------ --- - Alterations and/or-recommendations:,_-._ - ------------- E.� . ----------------------•---------_--------------------------------------- ------------- --------------------------------------------------(-��-------- ----I---------------- ---- --------------------------------- --- Date--------- 7 FINAL INSPECTION BY----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 30D Wes+ Oak Street Y Tracy, California Stockton, California Lodi, California Manteca, California Y. ES--9-2M io-52 Revised W-2100 -