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w APPLICATION FOR SANITATION PERMIT Permit No. ....v_-.. (Complete in Duplicated ;.-f Date Issued e t : . i ` plica,-ion is hereby made o the San-Joaquin Local Health District for a permit to construct and install the work erein described. gThs application is made in compliance with County Ordinance No. 549. t JOB ADDRESS AND LOCATION-------- ------------------------- --- � -�- -- •- - -- - ---- - --• - --------------------------------------------------------------._- ._ , eek •---- KA Owner's Name -- ----- _ Phone . ---- ---------------------••---------- Address ------ Contractor's Name -------------- one... ------------------•------ r 40 ❑•-kTrailerfCourt, - —Motel+ Other Installation will serve: Residence ❑ ❑ ❑ r - Pc artment^-House.0—Commercial Commercial Number of livin uni hs: _41---umber of bedrooms�� Number of baths _-I__ Lot,size _ - -- ;_ +Ul----____s...-__---- 4 g Water Supply: Public systeipm ❑ Comrfunity'system'❑""Pi`i3ate Depth to Water- Table_ j ft. s '� f. ' + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Mobeg --Hardpan [] Previous Application Mader Yes ❑ No XrNConstruction: Yes A �No•❑ �" TYPE OF INSTALLATION ND SPECIFIewCATIONS: .- No septic tank'or cesspool permitted if public sewer is'available within,200 feet.). Septic Tank: Distance rom nearest we�l1l___�d Distance�fram founda�tion__�D� + __.Material___ _:. -- {ybA INo. of �om artments_.-#..;L s--Size�� d---�.�---Liquid depfh____y a--- .---- `Capacity____E____ t _ len th ofeach line_____ -S Distance to nearest lot line: _________. Number of lines ; --- g ` d . .�- :Width of trench r�� C_ Dis osal Field: Qistanc�.from nares l ell.:.___ -=__;v.Dis#ante frAm fours atn t ' f Type or filter mA ial- ► Depth�of filter m aerial_ j _Total lengthA "�° - ' 1�tO .Distance to nearest lot line__.____---- N . . __ Seepage Pit: Dis#anC to nearest well �_4_ -- ---- nfce foto=#ou datf N pa �mber of pits__} f -- --Lining 4 at rial ySize Dierrsete _ Depth .~ 1 : _ ♦. Dze�Di meter nearest well__.---------------De tthCe�_�_-------------- - -ion-•-- --�--- -,Lining material-------------------------------------- Cesspool: • �. om, ours at ' ❑ 1 p # � - I Liquid Capacity-------------- --- ----gals. ' Privy: Distant from nearest well- ------------------------ ? Distance from e res t buildmgt_ --=__-_--___ ❑ Distance to nearest lot line . �" ---- t----- • ---- - Lk ' Remodeling and/or repairi Pg (describe):-------------- t! ��. -- --- - - --------•-- ------------- ! , --------------------------------------------- p _ P ------------------------------------------------------------!kr -------------- - - ----- - --4-------------------- that ___ = = =-W ! here"certifyave prepared this application and that€the workwill•be done in accordance with San Joaquin Cunty_,ordinancesrules and regulations of the San Joaquin Local Health District. (Ow rand/or Contractor) (Sgned)_ Y { SY� / ------------t = " --------------(TitleJz.- ------ ---------------- Plot plan, showingsize of 114, location of s em-in`relation to wells,}bus, !etc., can be"placed`on reverse side). �.... FOR DEPARTMENT USE ONLY, kL�: APPLICATION ACCEPTED BY--------------------- --------------- - - DATE--------------- - ------ REVIEWEDBY------ I$---------- - ------------------ ---- ----------- ----------- --------------------------=-A -- DATE------------------------------------------------------------ BUILDINGPERMIT ISS UED-------------------- ------------ - ------=s--------•--------------`---------------------=------.'DATE =' = = ` , - . ..:Alterations and/or reconmwndations: ,---------------=--------------:-----------------------•-------- ------------.. ----------•--- -------- --- � ------------------------ --------------------------- - -- -----------•--- ---------- -------- -- ' r �r - . I ------------- , . ---------------------------------- ------------- •-- ----- ---------------------- --------------------------- - ----------------- ----------------•---- -----------•----- i f ?FINAL INSPECTIONTB -----. � ._._ . _ ._ Date-------- -----=------ -. Mm. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stre t 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised W-2100