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__.11._-I-�-{�---• ' APPLICATION FOR SANITATION PERMIT Permit No. / (Complete in Duplicate) Date Issued `Joaquin Local Health District for a permit to construct and install the� Application is hereby made to the Sanork erein d scribed. 11 This application is made in compliance with County Ordinance No. 549. / �.. _ ---jod----- l JOB ADDRESS AND LOCATION____ . �.. ._, Phone-- ---------------- ---------------------------- '- --- ----------- -- --- -. ------------------- Owner's Name ?jam V ------ Address--------------- '� ----- Phone P/+._ ----- Contractor's Name------------ - �. ' Motel ❑ Other ❑ Installation will serve: , Residence Apartment House ❑ Commerc+al ❑ Tra+ler Court ❑ /�•!� Number of living units: _ ___ Number of bedrooms ez -"" Number of;baths l_ Lot size ____.N - -- --- — j r_ Water Supply: Public'..system-❑'"Community system F-1Private'�Depth to Water Table+",,7_ ; Character of soil to a depth of 3 fest:ISand ❑ Gravel Sandy Loam y�- Clay Loam El Clay ❑ Adobe ❑ Hardpan i 1 Previous Application Made: Yes ❑ No P-'-N'ew Construction: Yes U?Ilqo E] FHA/VA:Yes ❑ NO r TYPE-OF rINSTALLATION AND SPECIFICATIONS: (No septic;+ank-or:cess ooI ermitted_if public sewer is available within 200 feet.) T� � - _ , 7 rK F �w.r spa „y.i ..i.i - ~ -----_.----- p -*P - . Material // 1 t Septic Tank: -Distance from nearest weII_:f�J ---Distance rom foundation;. f e - C-- ac �Q - r No. of com artmerits__-- }Size_ -- -- Liquid depth:__-- - ------ P Y �" p - -- i �. : l. . s 1 "____. _.-_.Distance to nearest lot line______ Disposal Field: Distance from nearest well__7t*-------Distance from faundatiorn_ _ ` ,..r., Width of'trench fi� Number of lines_____- ._- -- ------ ength of each line__ _._-•------7-�---- �r p --Total len th-'------� 10----------------- Type of filter materialA� -- -- ---Depth of filter 'Material___: iJ�--.---� g , 1 Z� � . . �} S epage Pit: Distance to nearest well_,-_ _--___Distance from fo ation___._ _. ___.Dist ce to nearest lot ine___r...___.___.. _ r .,.�. -------.De Depth_- Number of g , . p e I�.urnber of pits-�_.�"-.-.--- -=--Linin matersal�L Size:.Diameter._-"- Cesspool: Distance from nearest`'well----------------- from foundation____________________Lining material_______- De th----- -- =----- b---------------- Size: _ Liquid Capacity - gals. ❑ Diameter---- t : - =_ p rt i T - . I �""�_-_____Distance from nearest building Distance from nearest well------------------------------- Privy: - - - --------------------------------------------- - ❑ Distance to nearest lot line_."':----------- ------=------------' -`- � _ g =--- ------------ -------------------------------- Remode4in and or repairing (describe):_____---:-1' _ - / .F ______________ ___ ----------------------------------------------- ---------------------------------------- ------ -------------------- .. ------- - ------ --- --- - ! hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin L cal Health District. --- r Contractor) (Signed ( +tI - -- --- ------- -- -(Awn -- -- ---- _ _ T eP �.. . .�� t" size of h-=" acation`af system in relation to wells, buildings, etc., can be lace reverse e)• t (Plat plan..show+n9 s c - FOR DEPARTMENT USE ONLY DATE-----);f----------------------------------------------- APPLICATION ----------------------------------------------APPLICATION ACCEPTED BY_-"-------------------------- _------ DATE----------- REVIEWEDBY------------------------"----------------------------------------------------------- - -- ------- �c ----------------------------• ---- = --- 'DATE.----- % ------ - BUILDING PERMIT ISSUED------------------------------------------- .. ' n ...---V-- - Alterations and/or.recommendations:-------- ---- �+i------------------------------------------------ 1,--;-.. -•`�-------------- - ------- -------------------------------------- I' ____________________________ Y _ -------------------------------------- __________________"--_._--- ---- i �i _ ------------------- [STRICT-1i, A—Date__— .� -- -------------- FINAL INSPECTION-BY:-----' - - ---------------------- FINAL - - - - - -*SAN JOAQUIN LOCAL HEALTH DI57RICT ' - 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Trac California Stockton, California � �,. Lodi, California Manteca, California Y, ES--9-2M Revisea 1-57 F.P.CO.