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FOR OFFI / t�f�-- Permit No. ..:_l..� .. _ G _ 3 r / 3 APPLICATION -FOR"SANITATION PERMIT - ---------1 p;? (Complete in Duplicate) Date;Issued __._._-_ _ _- _-..----"--- .-.-.___ This Permit l:x fires 1 Year From Date Issued } ,..;,4 Application is.hereby made-to the San Joaquin Locale Healfh District for a permit to cons u �a stall the:work herein described. N,This application is,made in compliance w'I�rljl rdinance No. 549. B ADDRESS AND L ATION----- _D- Phone--------------------------------•-- wners Name. �f ._.._17, -O. ---------------- AddressContractor's -.__•---. saG1- -----•-- Phone...................... Name------------------------------ --------- - " �t, r; Motel Other ❑ Ins+allation will serve:' Residence partment House ❑ Commercial ❑ Trailer Court ❑ -Number of living•units:'..• :__ N of bedrooms --. Number of'baths ___..__ Lot size ---------------------- We+er;Supply: Public system; Cornmunrt system ❑ Private ❑ Depth To Water Table ft. Y Y Cl4alacter of soil to a dep+h of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpbn ❑ Previous Application Made: (If yes,date--------------------1 No New Construction: Yes Jo ❑ FHA/up" Yes ❑ No I " OVi TYPE OF'INSTALLATION AND SPECIFICATIONS:. t ; (No septic tank or cesspool permitted if public s�.is available within 200 f� f �r� ✓ ; _ ---Material.'!_ r T r Distance frbm nearest w ance from foundation------ ----- --- 'f Size._�? 'depth-_._'T -------- i `No. of compartments--------------------------- O l rt line- � Septic ..Width of trench e . ....---•--- Disposal Id: Distance from nearest well t,Distance from founcdatpn _ Distance to:neo g - y Number of-lines.---------7�-----=---------Length of each line..---- `` $. /• l q' 'w Type of filter material•---rOe ---_Depth of filter material-_1 "_------Total length_-- - -•-•-----• --- - •, s YP eS y !_.._.Distance to nearest lot lin ---------- i se I€ � �� ,l: � C epag ft: Distance to nearest well"-_---__----_-_--_--_Distance frort+ foundation - • _ meter-��--�----•,----.Depth---�� ---• ,� Number of pits ell__________g__.__Distance from foundation_.___ Linin material-_ ----- a--------------Lining material--------------------------- Cesspool: ---- ----------------••----. Size: ie esspool: Distance from nearest _________n-.-.. ----_gals. C Size: Diameter ------ p ----=------Liquid Capacity :I Distance to nearest lot line------------------------------------------------•-----------•--=-=-m nearest building-----------•------------•----------------•. ,_: Privy .- r' �]Sstance.,.from nearest well----------------------------------------------=- _Distance ro !I ---• -• ----•------- ----••---•--;---•- Remodeling and/or repairing (describe):--------------- - --•--- ----••-•----------- ------ ------•- I = ------•---- ••...---...__..... --- - ---------------- ------ --•---------------------•--•--- - ------------•----------•----- --- ------.--.------.T;_------ --_- -- nd that the work will be done In ac .;' r+if a..l have eared this application a------ -------- ------ ----------- ----•- ----------------------------•-----•-------------------------------------�-------- ---- by accordance with San Joaquin County here y.`ce. Pp ordinances, S+04 I w ru an r gu'ations of the San Joaquin Local Health District. � (Owner and/or Contractor) - --- (Si ved ..___ `fly=........=== = E (Plot plan, showing size lot, Iota+ion of system in rea ion to wells, buildings, etc., can be placed on reverse'side). ------------ ZFOR DEPARTMENT USE ONLY APPLICATION AC16EPTED BY-------------------------------- -------------------= __r. :--- ---�-�'------- DATE---------------.._��--�---�;�--------•-•�-- ' REVIEWED BY------------------- --------•--------- -------------- -------------------- ----- -----------• ----- DATE .. �" ... - BUILDING PERMIT ISSUI~D__-__------"--- ----- TE ------------------------ - AFtera�tio�"�n or r gime dations:_.___ - /�! 1l ---- tM - N -- ` :--------------------- --:--- •---------- - r..l. - ----- --- --------•-------- ----------------- -- Date; _ ._. FINAL INSPECTION �i SAN JO QUIN AL HEALTH DISTRICT % 3DO Wesf Oak Streai 124 Sycamore Street 205 Wast 9th Street 130 South'Americon Street ; € II Stockton,California Lodi,California Manteca,California A1 Tracy,Californr�, ES 9 REVISE❑ 8.59 2M 5-62 ATLAS ' y