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APPLICATION FOR SANITATION PERMIT Permit No.j...�--�?---v- � (Complete in Duplicate) Date Applica}ion 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 Ordina o. 549W JOB ADDRESS AN CATION-__.-r . -------- , --- - i�_ y-.e__----- _- i/f•S Phon W 4 � Owners Name---------- .- ---- - ----------•- Phone l_16.9 6_i_o ---- Contractor's Name_________________ -�Ap Motel Other Commercial Trailer Court ❑ ❑ Installation will serve: Residenceartment House ❑ ❑ Number of living mbar of bedrooms _ -'Y Number of baths _ J-_ Lot size --- -------------- Water Supply: Public system �mmunity system ❑ Private❑ Depth to Water Table .-`71- 4t• soil to a depth of 3 feet: Sand Gravel El Sandy Loam [I Clay Loam❑ Clay ElAdobeardpan ❑ Character of P Previous Application Made: Yes ❑ No Ee New Construction: Yes ❑ No Lam" TYPE OF INSTALLATION-AND SPECIFICATIONS: I (No septic tank or cesspool permitted if pubo mower is available within 200 feet.) - �-�---------.Material -- ------ --------- -- Septic T Distance from nearest well- ---Distance from f undation___ is �. a ?K- Capacity ,;y�7 Liquid depths I_------ . No. of compartments-.._�--!-�---�---_Size_ __ 14 Disposal Feld: Distance from nearest well_ X..>�-Diste_fromG� 'on_1-_Q------ ----Distance to nearest lot line.___-s___-.___. _,,Len th of each line -Width of trench.-�-4/-'f'------------------- Number of lines---- ------------ fi f�} g If-- Type of filter material--- _ Depth of filter material_ ---__.____ Total lengfih___,�-0----------------------------- Type ----------•�f � e ' .__.D'sstance to nearest lot line------4------ 5eepage ------ pit. Distance to neare t well- ' '----D'sstan f fon atio ?/i De to w� �t Size: Diameter_-- - - i Number of pits--- ----------------'Lining material._____ ___._ -_ _- p Cesspool: Distance from nearest well_____:_-__-_____Distance from foundation__--_______.-------Lining material_-.______------------------- - als. Depth - - Liquid Capacity---------_---------- i.-- ---•-----•---------- 9 .�.._ _ :'— .-Size: Diameter----------------------------------- — ,�. _ - Privy: - Distance from nearest well______-------------------- - ----:r -Distance from nearest building_____--______________________ ❑ �•.._. Distance to nearest lot line---------------------- ----------------------- •-•---- --------------- ----------------•------------------- Remodeling and/or repairing (describe):______--------------------------------------------------------------------------------------------------------------------------•--------------•---.----- -- ----------- ----------------------------------- - ---- I her by certify that I hav prepare this zip ' titian ani+hat + e work will a done in accordance with San Joaquin County ordinance , Stat la.t(s,'a es and r 'ons f n Joaqui al th District. Wl� ontrac+or) (Signed) -------- --------------------------- ----- (Titl ---- ------------ - --- - (Plot plan, showing siie of lo+, location o system in rel a on to Is, buildings, etc., can be p se side). - -� FO EPARTMENT USE ONLY - ---- _ DATE-- ------ - --------------- -- APPLICATION ACCEPTED BY----------------------- ---------------------- - DATE.__._. -.- ` 1 REVIEWED BY-------------------------------- ---------------------------------------- 4 ----- ------------•- -------------- -------------------------- DATE-------•--------•---------------------- BUILDINGPERMIT 15 -------------- - --------------------------------------------- - Alteratians and/or recommen a ions:__..____________________ _ ----------- ------ -------------- --------------- ---- ----------------------------- FINAL INSPECTION BDate_Y:----- -- _.. v J� SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C' Street 130 South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California Y G111-4—?m Revised W-2100