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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .....Z-VI-54 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 Ordinance No. 549.. -ADDRESS An LOCATION_A JOB - - ------------------------- Phone-j*--- Owner's Name------ -i.--------- --------------------------------------- 7T- ----------------I--------------- Address------------ -- -- -- ------------ --- -------------------------------------------------------- . . . ............. Phone-44-1--k-f-a-0-7 - - --------------------------- -------------------- '"---- 4 Contractor's Name., -'-V-1._C4,- Motel [:1 Other [3 Installation will serve: House F Residence Apartment Commercial Trailer Court [1 16� 4 Number of living units: Number of bedrooms _-.0—Number of baths --/-.'Lot size Water Supply: Public system [] Community. .system [l Private Q. Depth to Water Table' ft. Character of soil to a depth of 3 feet: SandE] Gravel [] Sandy Loam El Clay Loam [:] . Clayo Adobe KL Hardpan 0 Previous Application Made: Yes ❑ No F] New Construction. YesNo TYPE OF INSTALLATION AND' SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y A 47 ---�?---�_-C------------ Septic Td�nk: Distance from nearest well_._`7"2 --Distance from foundation_-. ----•---- _Liquicl depth____.c .-_-_.--.Capacity....R-ep-h------ No. of compartments----_-. 4?v--- _e--- ------ Si, Distance from founda, Distance to nearest lot line Disposal Field: Distance from nearest well_4l�e___ Width of trench.__._a-,C Length of each line-------- - ------ --(---- ----------- Number ci� lines--------- te--- �epth of f, ---149 Total lerig+-------1,41---------------------- Type of filter material filter mate rial__.,�_ Seepage Pit.. -Distance tonearest well_..-.--___-_..- ---__Distance from foundation_____________- ______Distance to nearest lot line___.___.__.______ ---------- --------Depth.-----------7-------- ---------- Number of pits----------------------Lining material---------------------..Size: Diameter--- - Cesspool: Distance from nearest well-----------------Distance from foundation.--"............. _Lining material---._.---.----..--___-----_.---_--_--. � ❑ aterial-------------------------------------- D Size: Diameter---------------------- -- ---------Depth---------------------------------------------- -----Liquid Capacity-.------------------- -----gals.- nearest well------------------------------- ------. ..-Distance from nearest building-----.------------------------------------11; Privy: Distance from -Distance to nearest lot ine--- -- ----- -- ------------------- ------- -------------------------------- ----------------------------------------------------------------- --------------------------------------------------------- Remodeling and/or repairing (clescr'ibe):------ -- -----------------------------------•--------••---- -------------------- -------------------------------------------------------------------------------------- I --------------------------------------------------------------------------------------------------------------------------- 1 _.----------••-----------•--........------------- ---------------------------------- - ------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat and rules and regulations of the San Joaquin Local Health District. ------------------(Owner and/or Contractor) -- ---- --------- ------------ ------- (Signed) ---- ---------------------------------------------------- --------- --- -------------------- .1 ---------------(Title)..... ?. ---------------------------------------- -- ------ can be placed o 611s, 6uildin' -s. etc., n reverse side). (Plot plan, s owing size of lot, location of system in relation to. w g FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ------ - ---------- ----------------------- -- ---------------------------------------- DATE._:�L—-------------------------------------------------- ---------------- DATE---Z- ----------------------------------- ............ ---------------- REVIEWED BY----- ------------------------------ -- ---------------------------------------I------------------------- --------------- DATE-------7U�------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------------_----------------- .(3- -------------------------- -------------_-------- ----- --------- Alterations and/or recommendations-------------------- --------------;--------------------------------------------------- -------------------- ---------------------I----------------------------:_------------- ------------I-----------I------------I------------------------------------------------------------------................... ---------- ---------------- ----------------I-------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------- ------------------- ---•---------------------------- ---- --------------------------- -------------11--------------------------------------- ----------1.----------------------------------- -- ----------------------------------------- ---------------------------- ---------- ------------------- ---------- ------------------------------------ ------------- -----------------------------------------------------------j-----*-------- ------I----------- FINAL INSPECTION -------------------------------- --------—------- ---------------------------------------- L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWOOD