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j APPLICATION FOR SANITATION PERMIT Permit No. •-fes- f (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 apermit to construct and install the work herein described. This application is made lin compliance with County Or in ceyN .449;(�] - •---- --- _ ------ ------ - ---•-----•---•---•------ JOB ADDRESS AND LOCATION-------------- ---- Phone, -,fry-----��t�-_-��- ------- Owner's Name______t_______ -------- -- Address------------ -------- --- ------- ---- -----------•---------- ----- •-- ------- ------------------------------------ Name--------------------------------------------------•--------- - - - •t'``""'--'�� Motel ❑ Other ❑ Installation will serve: Residence E}-' Apartment House ❑ Commercial ❑ Trailer Court ❑Number/of b_ ______ YSa$!� -______ aths ----- --- - - '"jQ" Number of living units: _-,---- Number of bedrooms , _��_ Water Supply. Public system ❑ Community system ❑ Privater 'Depth to Water stable -------- ft. Clay Loa� [3Clay ❑. Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel ❑,,,,Sandy Loam Ely No �- + Previous Application Made: Yes 111 -..- No [4 'Ne%V'Co�ruction: Yes �' No E] FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted if public sewer„is•,avail--abke within 200 feet.) / �.-- --- stance from foundation_.._J' ;----.Material__ -�” ` Septic Tank: Distance from nearest well d '` Size V, � .Liquid depth--- - -------- No, -_�i No. of compartments---------�------i------- lQ�- ' Distance-fio nearest lot lin Dis os l Field: Distance from nearest welll!_��"L�'Distanc fro /]foun ati „ i Width_of trench______--- `-------------------- i P >f - ------ Len thQ, li .. -- Number of lines---------�'/ = 9 Type of filter mat G --Depth of filter material,__-V-j ---Total length_____ -----• • --' - ob I Seepage Pit: Distance to nearest•well____._____- --Distance from foundation______________ Distance to nearest lot line____"_____.___.. ❑ Number of pits ---�' # Linmg mateal _y� Size: Diameter---------- ----- - Depth - .......... Cesspool: Diistance from nearest ell- _ __..__Distance from foundation------------- -----Cining material-__._____..__._______________----- ❑ Size: Diameter-------------- ------ ---------- FDeptfa ) _Liquid Capacity- gals. .- -__---"__..Distance fromnearest building_ Privy. Distance from nearest well __,_ {�-~---- ---------- „yIy -------•--------------- ------------------------ Distance to nearest lot line--{:---- -- I f - -"-----------------------•-------------------------------"-•--- cri k Remodeling and/or repairing (desbe:- _- ----- - ------ - . �. -- --- ----------------k--------- - ='= W aw --------------- x~--------------- = _� - 4, , p licah pP a ttion and-that the work will be done in accordance with San Joaquin.Caunty I I hereby certify that I have pr e and this a e San Joaquin Local Health District. ordinances, State laws, and rules and regulations of e , 4----- (Owner and/or Contractor( ' ' ------------------ ---------- By: (Signed) Tale -----------------------------------------------------------=----------------------- - - - - - - ......................................... (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 ------- DATE--------------------�, �Cerb --- - ---------------------------- APPLICATION ACCEPTED BY------ ------ -------------------- -- ------------------- REVIEWED BY------------------------- ----------------------------------- -- ------ ---------------------------- - DATE"---------�-- --------------------------- --- --------------------- - --------------------- BUlLDING PERMIT 15513ED------------- --------------------------------------------•- -- Alterations and/or recommendations:-- ------------------ -------------------------- FINAL INSPECTION BY:-----L'--`--� ---•----- Date-- ------------------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West,Oak Street 132 Syeamore Street 814 North "C" Street l30 South American Street Trac California Stockton, California Lodi, California Manteea, California Y� FS-9-2m Revised V59 F.Q.CD-