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FOR OFFICE L )E APPLICATION FOR SANITATION PERMIT Permit No. ---- ----- ---------------------- ----------- -------------------- r- -------------------------------------------------------- (Complete in Duplicate) Date Issued // t - --------------- This Permit Expires 1 Year From Date Issued 2-2_lpr—OPO Application is hereby made to the San Joaquin Local Health District for a permit t construct and install the work here')n descril:oecl. This application is made 1-,-s-,pI--nce with County Or inance No. 549. V 7 Or ................ 2Z ------------------- ........... ---- ----------- ATIO' JOB ADDRESS N Owner's Name-- _ ,Phone.... ---------- - ------- r44. A Acldress__,.*e _gz-:� A*""� ---------------------------- ........ .......... Phone.."60... Contractor's Name. ......... .......... ............ Motel ❑ Other 0 Insfailaflon w3l"sier4e: Residence []wr"Xpartment House [I Commercial Trailer Court ❑0 Numbe'r.,of liv'ing units: Number of bedrooms &-. Number of baths Akot size ....//0 ---------- Water Supply .Public system El Community system Cl'! Private epth TO Water Table' ft- Character of soill.toa depth of 3 feet: Sand [] Gravel E] Sandy Oarn[] Clay Loam [I Clay 0 Adolb d n: Yes4g�<❑6 FHA/VA.. Yes,;�WNo 1-1 Previous Application Made: (If yes,date--------------------I No Constructilo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubk sewer is available within 200 feet.) � m rQu n ion---It--------Material----- Distance from nearest well_ _..Distance from f --claf Septic Tank: Z'.-,.t � -----Liquid dep�h__,g .........Sizej' ------Liq ...... No. of compartments-.O__ W". -lot line Distance from near .....j Disposal Field: we 11.'1155 ----Distance founclation-4 ----[Ysstanc� to nearest f._._.___.... Number of lines--- engfh of each line_J1.**4- -----W_Width of trench.__._ Type of-filter material- epth of filter material------ -----Total length----8--io----------------------- See Distance to nearest weY_ --Distance from foundation------k..C.!�Distance to nearest lot line Number of pits.........I---------.Linin material-R-6-1 Cjj Size: D ia mete Depth- ................ Cesspool- Distanct from nearest well---------------- Distance fro foundation ._._______.__-.Lining material____._--.--___--_-____..._______---.-- ❑ Size: aterial-------- ------------- ---------------- Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----_--------------:------gals-(�_ Privy: Distance from nearest well---------- --------------------•---- - -_-.__--Distance from nearest buildin ------------------------------------------0 0 Distance to nearest lot line------------- ------------------------------------------------------------------------------------g--••--------------•--------------------- Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------------.......------------_---- ---------------------------------------I-----------------------------I-------------------------------- ----------------------------------------------------------_------------ -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------I herella-y.-ce---i-fy_.that I have prepared this application and that the work will be d e in accordance with San Joaquin County f h S Joaquin Local Health D' ric+- ,be e %ce 'it, �+, D, riot. ordinances, St ws nd rules a�d regulations o e an Contractor) (Signe ) ---------------d).---- --- ------_4 -y_ _ _A4 itle)----_------------- ----------.......... . .......... ........... By:--------------------_- -------(T* of system in relation f�Lel�ls, 6uildings, e)t.. can be placed on reverse side). (Plot plan, showing size of lot, location FOR DEPARTMENT USE ONLY-' ----------------- APPLICATION ACCEPTED BY---- J 3-0------------------------------------------------------- REVIEWED BY ------------- DATE----- ------------ DATE---------------------------------------------------------- ------------------------------------------------------------------------------- ----------- BUILDING PERMIT ISSUED-------------------------------------- ----------------------------_-- ------------ ------ DATE_--------- ATE......... ............;------ ------------------------------- 5. -, ,q ------- ---------------------_--.-_--•---- ----------------------*------- ._5 -----------------------------------I........... ------ Alterations and/or recommendation -------------- ---- ------ - ----------;�,15-----------To------stqr�jo -------------- ------------- --------------------------------------------- ......P't- �F_-:jFT4-S -A@!;*' ------------------------ ----------------------------------------------------------------- ------------ ------------ --------- ------------------------------------------I--------------------------------- -------------------------Tl_p ------------------------- ----------------------------- .................. ----------------- -------------- . . ..... ... ----------------------_----------------- --- ---------------------- ------------------ ------------------------------------........ ----- - - -------- Date--------- ------- ---------------------- FINAL INSP N B Lj2L........ --- --- SAN JOAQUIN LOCAL HEALTH,DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS