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F R OFFICE USE: // APPLICATION FOR SANITATION PERMIT ------------- --/-�---- Permit No. 7,. .... - f '/ 4 .... ------------- (Complete in Duplicate), Date Issued This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District.-fora permit to construct and inpa}the work he i� es e r This application is made in compliance with County Ordinance No. QCs t ' -fdr - JOB ADDRESS A D LOCATION.. , - - ----�.:LL?-.------ -- - -- -- ----` A,,y------------ ------------------- Phone------------- --------=- Owner's,Name--- ---- --------------------------------------- Address / `A._1__ ------------ ---- ------------- LPhone----------------------------------- ------------Name__�+"�' di,c� ,. - "'_7 �'-�""�`-- f• ----------- ! - ` Motel ❑ Other Installation will serve: Residence Apartment House ❑ ommercial ❑ Trailer Court ❑ R ❑ /_-__ Number of bedrooms - -.!Number;of the _p-Vt size .------- _.____.2 ..-Z -------------•-- � Number of living units: _1 4 � t f Water Supply: Public-system ❑ Community!system El Private Depth to Water Table ft. �No ❑ Adobe Hardpan ❑ Character of,>s?il to a depth of 3 feet: Sand ❑ Gravel ❑ �andy Loam Clay Loam if es date....-.__-.'_,_.. -.. No ❑ New Construction: Yes FHA/VA: Yes ❑ No.❑ Previous Application Made. l Y . TYPE OF INSTALLATION AND SPECIFICATIONS: -11 ._. . (No septic tank or cesspool permitted WP yblic-sewe_r_,as available within 200 feel`) , Material- -- ------------ e ---------- dQ Septic Tank: Distance from nearest well__ _- ________Di. tance fro �foun on__ __--------------- -p Ca Capacity `1�� ' No. of compartments_- ___.--Sie_�..__i+� Li Liquid de th__ ------- q P. - - ----- -- P Y Disposal�Field� Distance-from nearest well_1/6-47...,Distance from foundation_.®:_______.Distance to nearest lot line -- _...3 Number of I•snes__ _ ._._.__-.__ _ _ Length of each linG__`�a�--, fWidth of trench_. _.__ _---�_._ fe z n i /� -0 Total length r . Type:of.filter material �IiA_ :--Depth of.filter ma erial__� ______,,____ g l � sP _Distance from foundation__- - s � kine___ Seepage Pit: +� Distance to nearest well_�•� - �i`------ Distance to nearest lot - o� Number of,pits----2E_'------------Lining material-R.O.- �--------Size: Diameter._ �3-.--------Depth_ c ------------------ ' Cesspool: i Distance from"-h arest'well_-___:.__---_M'.Distan.ce from foundation____-_-__._ _.__.Lining material____ __ _____-____. ❑. i Size: Diameter--: !ne----------------- Depth-----;--------`------------ - ---------- -----Liquid Capacity-- ------------_ ----------gals. Privy: Distance from nearest well-----------------------A----------- Distance from Barest.building-F_-_____.______-------------;---. c:. ❑ i Distance to nearest lot line--------------- ------- -----------------•--------------------------- i -i---------------------------------------- Remodeling and/or repairing (describe):--------- ---------------------------- - : I ! -------------- ----------------------- ---"----= = Y = - } 4. ------------------------------- t ----------------------------------------------------------------- - -----------------------•----- -----------------------•------------------------------•- --------•----------------------------------------------------- I hereby certify that;l:have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. "' ° f }�t f to --------------•- -- -------- - �- r ant,actor) i (Signed)_S - /tl f / r At- - -r� -- C By:---------------------------------------------------------------- (Plot -----------• ---- - - (Ti+1 e)----- - -- ------------------------------it,(Plot plan-, showing size of lot, location of system in rela+i wells, buildings, tc., can be placed on reverse side). :.r : . FOR DEPARTMENT USE ONLY APPLIC�I DATE-------sP�/Q r �` REVIEWETION ACCEPTED BY------------------------- - ----- ------------------------------------------ ------------------------------------ -------- D BY-------------------------------- ------------- -------- --------------------------------------------:----- DATE-----------------------•----------------------- •------- I BUILDING PERMIT ISSUED------------------------------------:------------------ ---------------------------- QATE - - Alt e a+ions and/or rete nrriendations:_______... -------------•- ---------------•----•------------------------------ --- - _ -- -------------��------------------------------------------------ ------------------------------ --- ------ ----- -- XI � ----- FINAL INSPECTION BY:-------- E"--------------- Date 7 � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 :3M 3-'63 F.P.C17. 1