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7 I ' Permit No, ..,�y�-�•�--� F APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued 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. ' ---•-----------• ------------------------ a ---1 -- •- - --A JOB ADDRESS AND �K�5_ 76_Al 0N-•------�'�-- -- --------�� - �� --- ---- - ----- --------------------- --------- Phone-�:✓�Owner's Name_____________ Address------------------------------� -y ---- ' c _C)_ Phone---------•------------------------- Contractor s Name------------ V-"---- � Motel Other El Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: __l-_ Number of bedrooms ---�_ Number of baths _-_/___ Lot size _______ ��C/ Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ Previous Application Made: Yes E] No M New Construction: Yes El No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer wer is available within 200 feet.) Material--------------- "- -- -- --------------- Septic ----------- Septic Lank: Distance from nearesr well___" -----Distant lfrom foundation___._ _____"--- - Ca Capacity Q ' No. of compartments------ Size_!.X4 Liquid depth . p Y Disposal Field: Distance from nearest well---� /_Distance from foundation___lC�' -.Distance to nearest lot line Len th of each line--------- fir Width of trench------- -------------- 1 19 Number of lines------------------------------Ir g f Type of filter material__'��4----Depth of filter materiial____.___1��---Total length____r�,9--=------------------------ ion -----------`- - . ry f 1 r Seepage Pit: Distance to nearest well.---1-63-�-Distance from foundation____ Q_.--_.D'sstance to nearest lot line_ _____.. D +r Number of pits---------�---------Lining material-___.lti v�y�Size: Diameter----•-�. ...-----.Depth--------coy ��--- Cesspool: Distance from nearest well________________Distance from foundation____.___________-.Lining material_--.___-_-_______---___.____-_____-- Liquid Capacity_ gals- El als•❑ Size: Diameter------------------------------- ----,Depth--------------------- --------------------- - Privy: .: Distance from nearest we41-------------------------------------------------Distance from nearest building_---------------------------- ---------- ❑ Distance to nearest lot line----------------------------------------------------------------------- _ _ _____ Remodeling and/or repairing (describe):---------------f--------- __ _ ___________ w , - --------------------- - --------------------------- �� -- � --- ---------- ---------------------- ----------- --------------------------------------------- - ------------------------------------------------------ --------- h s ! hereby certify that I have prepared this application and that the work will be done in accordance with an Joaquin County ordinances, State IT. nd rules and(eg�aliions of the San Joaquin Local Health District. (Signed}_ -----. -- ---(Owner and/or Contractor) -------- ----- ------ -----------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 l�_.�? - 1; --- -------------------------------------------------- REVIEWED BY------------------------------------------ - -- ---------------- Y DATE_" ----- BUILDING PERMIT ISSUED --------- DATE = ------------------------------------------ ; ---------------•-'--•----------------------------- ------------- Alterations and/or recommendations:-------.____-_._____..__--------------------------- -- ------------`------ ' - --------------------------------------- -- --------- •---------- --------- ------ -- FINAL INSPECTION BY.__-- Date.------ ��f -0-------------------------- ------ SAN JOAQUIN LOCAL. HEALTH DISTRICT 132 Sycamore Street 014 North "C" Street 130 South American Street 300 West Oak S+reef ,, _ Trac California Stockton, California Lodi, California Manteca, California Y k , ES-9-2M Revised 8-'59 F.P.Co.