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=�F'O - Permit No. ..- I APPLICATION FOR SANITATION PERMIT(Complete in Duplicate) Date IssuedThis Permit Expires 1 Year From Date Issued P A lication is hereby made to the San Joaquin Local Healfh District for a permit to construct and install thework herein described. This a plication iso in compliance with County Ordinance No. 549. ��/5 JOB -------------- ADDRESS D TlON__ - - � `- — -.. vEYE-a� Ph one --- - Owner's Name G --------•----' ----•------------------------a �/ � Address - ---- 3 ® Phone_4w� 96e�'----- for's Name Name__________________________ Motel Other ❑ installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units:--/--_ Number of bedrooms _-2r- Number of baths __I--- Lot size ------ ` ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table �i�ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel C1 Sandy Loam ❑ Clay Loam El Clay +dobe C] Hardpan C1 4 Previous Application Made: (if yes,date--------------------I No� New Construction: Yes ❑ No X FHA/VA: Yes ❑ Ng,'� F - TYPE OF INSTALLATION AND SPECIFICATIONS: ailable within 200 feet.) (No septic tank'or cesspool permitted if public sewer is av k Septic Tank: Distance from nearest well--- --.---Distance from foundation---------------- --Material------------------------------------------------- ❑. — No. of compartments --------- ---------------Size-----------------------•-------•Liquid depth-------------------------,Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------t----.Distance to nearest lot line--------.---_--._ ❑� Number of lines--------------------- ------------Length of each line-.--:------------------- .Width of trench----------------------------------- "- Type of filter material-------------------------Depth of filter material----------------- Total length-------------_-----line--- ------------ Seepage Pit: Distance to nearest well------Ls _`---Distance from foundation---_ •---.Distance,to.nearest�lot line--SO:�_ j Size: Diameter----.-`,��_._5"'_.• L1��pt" Number of pits___------/---- ---Lining material-el?Ls ining Cesspool: Distance from nearest well---------------- from foundation.------ - ,rk_ o Linuid Cateacil gals. Size: Diameter----- -----------------------------:-Depth----------------------------- q p tY ❑ Distance from nearest building----------------------------------------- N l Privy: Distance from nearest well-_-_--_----------------------------- i - - ------------ -------------- ------------------------- ---------------------------------------------------- - ----- Distance to nearest lot line------ ---- - - ------- ------------------- ------------.---- ------- , . Remodeling an /or repairing (descri t , - --------•------ --------------------------------- N I hereby certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State laws,and rules and regulations of the San Joaquin Local Health District. ---------- --------------------------(0 ner and/or Contractors . BY _ I (Plot plan, showing size of lot, location of system in a+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY `mac-*3' = ------------ APPLICATIONDATE r� ACCEPTED ----.- .- - -------------- ------ -----------•------------- DATE-- --------------------------------------------------------- ---- --=-----•----------------------------------------------- REVIEWED BY I DATE---------------=----- ------------------------------------- -------------- BUILDING -- -------------------- 1 i BUILDING PERMIT ISSUED----_------�w� -----=-------------------------------K----_: �-------------- Alterations and/or recommend ations:-_. - `lrJ, l ----�� c� �C �Y ��` -- ------------------------------------------------------ ----------- ------ = ------------------------- i --------------------------------------- -----------i � ----------------- ------------•- ---- ---------------------------------------------- -- --------- I _ ._. - - Date _ T •-� --''�-----f�� --- -------- ---------- ---- --------------- FINAL INSPECTION BY:----- - 4 c ;: I SAN JOAQUIN LOCAL'HEALTH DISTRICT 1801 E.liazalfen Ave. 300 West Oak Street 124 sycamore street 205 West 9th Street � Stockton,California Lodi,California Manteca,California Tracy,California gg g REV15ED 0-59 3M 3-'63 F.P.Ga.