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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .�1�---------- -- ---- --- (Complete in Duplicate) Date issued This Permit Ex iris t Year From Date Issued Application is herebymade to the San Joaquin Local Health Disfrriic 5 9 a permit to construct and install the work herein described. This application is made in compliance with County Or in , I c JOB ADDRESS ANDiLOCATION._ rr!'J.�1. � Phone----g-3-r-----4 Owner's Name-------- -1.m---- _� . Address------------------- •- t . ------ Phone---- I Contractor's Name__--- '- - Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 1 -� ��, Number of living units: _�----- Number of bedrooms __3 Number of baths __ . tot size __.--.1 �� , gu,. �K,ro� ,- Private Depth to Water Table 1fft. Water Supply: Public system ❑ Community system ❑ Adobe Hardpan ❑ Gravel Sandy Loam Clay Loam ❑ Clay ❑ ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ New Constru.'tion: Yes No E] FHA/VA: Yes ❑ No ! previous Application Made: ( f yes,date--------------------1 No� TYPE OF iNSTALLATI)ON AND SPECIFICATIONS: i (Na septic tank or Cesspool perrtAffryd- if�ubli i ew r is atl letvrithin 00 feet.) t-Q-------- t7/( Septic Tank: Distance from nearest well__l Size-TZ-1010 ze- ce from founda ion_-- 0 ��4..�. Not of compartments--------'2............ _- -"-I Size__ ___� - Liquid de'th----------------- Capauty-• - Width of trench.______ -na-__- stance from ne i eaor st well__ DLenath ofeach line actio Q ---------Distance to nearest lot li e Disposal Field: f _ _ �/�/--- -Tote �r Number of line____------ -� . g 7 h� .�t__ � ----- �„ ,� ,d }h of filter material------- g,;;,; e of�filter materiah_=,__ Dep Yp ,.*. '�_.D.,istartcto nearelot line_---------•-_--_-- t y. Seepage Pik Distance t5nearsf'tiv.el�1:':-e--------------- --Distance from foundation_ --•- --;- DepIt Y l��ewr, of*prts °3• yni matenal -- I ❑ 'Distance from nearest well_________________ � istance from fou'n`dation_ -._._ ._.__ _. Lining material.___ ----------- -- �-- - gals, ' Cesspool: Depth------------------------------ ----------Liquid Capacity .- : :- g ❑ 4 Size: Diameter._------------------- tante from nearest uil i ----------------------------------------- neo,.. D is b d ng ��"•rPrivy: .,,,D.istancetfrom�,. rest we�l_-�---'-_----�- - I ❑ Distance to nearest lotFline------ ------------- - -- -------- --- - rU- '- ---------- p7 0 Remodeling a•d/or repairing describe),.,, ------------------------------------- --- T� . e,ro -- --------` --------------------------------------------------------- --------------------------------------- ------------------------------------- ------------------- - -------- =----------- ' ' ------------------- ------- a `^ ----------------- ,�` -- - -- I hereby certify that I have prepared this application and�that�thewark will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the SaniJoaquin L`ocal�,,Health.Di®trict � M1 --(Own errand/.or,Contractor) f. By-------------- € - � (plot plan, showing ze of.lot, to ion o stem.in relation to welis,,b ildmgs, etc.,yca 'be laced on reverse_side FOR DEPARTMENT USE ONLY ` DATE---------- -------------------------------------------- ---- APPLICATION ACCEPTED BY--------------------- - --------------- --- -- - ---- DATE--- REVIEWEDBy------------------------------------ -------------------- DATE---------------------------'------------------------------- ----- -- ---- ------------ BUILDING PERMIT ISSUED -r ..=r --- ------------------------------------------------------------------ --- ------- - ----- - , Alterations and/or recommendations:._.- ;----- ---------------------- -- -------------------- ------------ ---- ----- - --- --------- Date----------✓<-- - .__J_ ------ ------"---------------- i FINAL INSPECTION BY------------ ----- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycarnore street 205 west 9th Street 1601 E.Hazelton Ave. 300 West Oak Street California Lodi,California Manteca,California Tracy, Stockton,California