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Permit No. ... .- .. APPLICATION FOR SANITATION PERMIT �. (Complete in Duplicate) - Date Issued ------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per it to construct a insta4l the wor etein described. This application is made in compliance with Coun y Ordi eN0 __&_: __j f >- - --- -------- JOB ADDRESS AN LO ATIO / �Q0-7 ------------ Phone_ r'J Owner's Name---- �.�''" ------ �. Address-------------- - •. ----------- Contractor s Name------____ . _�_..__. :_- ---------------- lit.- -- -'-------------------._ / Motel Other '❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 0 -(1_'....z� ,1---- -p-- Number of living units: ---- Number of bedrooms -�/Number of baths -------- Lot size _.---- .-- Water Supply: Public system$_Community:system ❑ Private ❑ Depth to,Water Table __ ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel El Sandy Loam El Clay Loam El Clay El Adobe Hardpan El Previous Application Made: Yes ElNo ElNew Construction: Yes E] NoFHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.] f Distance from nearest well _ _____-Distance from foundation__._--------------.Material"_.----_____".-._-._----__.-----._..- .-.-----.- ~~�L No. of compartments ----Size--------------------------------Liquid depth_--------------- ---------Capacity-----------------------� as F l`d� Distance from nearest well-�`_`f FK^_.Distance from foundation-r S /_--.Distance to nearest lot line. Number of lines_--._1_____ ___ _ ______ Length of each line---------- ---.Width of trench-------i- --- ------------------ --- _-.._..-----_=: I Total len th----s��2 -f----------------------- g d Type of filter matenaitj--Depth of filter matenal_f_ \4 �$eepage Pit: bis#ante to nearest well-----------------------Distance from foundation-:-----------------.Distance to nearest lot line------------ . ' Number of pits. ------Lining material-------------- --------Size: Diameter----------------- ----Depth_ - Cesspool: Distance from nearest well_.________._.__Distance from foundation--------------------Lining material gals. ❑ Liquid Capacity------------ --------------- Size: Diameter--------------------------------- ------Depth------------------------------ ----------------------- g E ---------------------------------------Distance from nearest building------------------------------------------ Privy: ---- --. Privy: Distance from nearest wellf Distance to nearest lot line_------------------------- ---------------------------- ------------------------ i ------- -------------- -- - Remodeling and/or repairing (describe):___.____ ____ _T - r Al ---------•------------------------ ----------------------------------- ----------------------------------- --------------------------------------------- ---------- - ---------------- --------------—----p---'---------tions of the"San Joa um r, I hereby certify that I have re ared this a lication and that the work will be done in accordance with San Joaquin County j Loc 1 Health District. I ordinances, State lawnd rules and reguia q ------------------------ ontractorl i SEPTIC TANK SERVICE: -----(Title)--------------------------- -- ---- ---------- ------------- ------------------------- (Plot -------- - - 9i o ing sAve:;" loca bu' ings, etc., can be placed on reverse side}. (Plot plan, showing size of lot, loca�n of system i r ation to wells, - - R DEPARTMENT E ONLY A. APPLICATION ACCEPTED BY ------- ------ -- ----------------------- ------------------------ DATE--------- �f--------------------- REVIEWED BY.---------------------- } DATE----------------------- -------------------------- -------- t •------------- --- - ---------------- ------------ -----------------------••------•------------• BUILDING PERMIT ISSUED-------------------------------------------------------------—-------------------- --- ------ DATE-------------------------------------------------- r. Alterations and/or recommend ations---------------------- ------------ ---------------"-------------------------- -------- •----------------------------------- -------------- --------------------------------------I------------------------------------------------------------------------ FINAL -------- - FINAL INSPECTION BY:"- - - ---- --------- ---------- ------------ Date-=----- ----- - ---- ---------------- SAN JOAQUIN LOCAL HEALTH .DISTRICT �* ' 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y. k ES-9-2M Revised V59 F.P.Co.