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- -- -,°R w FOR OFFICE USE: �'iW--- / .__ "" " APPLICATION FOR SANITATION PERMIT Permit No. a ---------------�� eia-..------ (Complete in Duplicate) Date Issued -------------- This Permit Expires l Year From Date Issued cal Health District for a permit to construct and install the work herein descri Application is hereby made to the San Joaquin Lobed. This application is made in compliance withCountyOrdinance No. 54499.. / /0-1.1 , � �J�_� r JOB ADDRESS AND LO CATkON S�-S/( N /rr _ -_ Imo.._-----Aw-----�" � 9 :/' ./—V�" - d Owner's Name- _-- - _ ---- ----------------------------- ---------------- Phone " e . 7 - ----- Address A one •--------- i Contractor's Name------ _ _ Motel ❑ Other ❑ Q 1. -� Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court i ---- Number of baths - Lot size ---944-. --- Number of living units: _- "" Number of bedroomsry " ft. N Private Depth to Water Table / le Water Supply: Public system ❑ Community system ❑ Y Adobe Hardpan ❑ nl Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Cla ❑ 0 f FHA/VA: Yes � No ❑ � -.l No � New Construction: Yes No ❑ F Previous Application Made: {If yes date_____________ __ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f� Mate fal__L�r-- '_.�dr - -------------- Septic Tank: Distance from nearest w IL__ad-- ----Distance�om foundation_____- " `� -Ca Capacity/ - ---Size��__]C, i�_X Liquid depth-----' -------------- P Y No. of compartments"�----------- - r. LA Disposal Field: Distance from nearest well. Distance from foundation.-./V --Distance to nearest lot line-z", r� Length of each line_ Width of trench__.__ Number of lines___ ___________ g ��-"----- ''� - "------------------ 11 �------- ` f- - -' ¢ Type of filter material �j��L�° Depth of filter mate rial___�--------�----Total length_,`�� ----- ------------------ Type ----�- 1/f Al Seepage Pit: Distance to nearest well -"-_--Distance fr m fou dation__ !. ___.----.Dpista� e to nearest lot line__ .----- - -Size: Diameter__J-3-----------Depth --- Number of pits._-""-----------Lining material__ _ - -"l�/e� 000 ing Cesspool: ,' Distance from nearest well_________________Distance from foundation----___ _-" Linuid Capacity gals. ❑ Sze: Diameter--------------------- ------- ------Depth- ----=-- -------- ------ ---�--_- ._. ------ _- "--. _._Distance from nearest buiiding----------------- Distance ------- ------------------------------ to nearest lot line----- -------- ------ ---- ----- -------- -•------------------- � Remodeling and/or repairing (describe):__------- - - - -- --------- - -------- ----------------------- -- --------------------------- , done I herebycertify ify thaa I have lespre aregulat oas olf the San Joaquin LocalkHeal heDistr ctn accordance with San Joaquin County ordinances, S } -- -- ---- - -------------- -----� -- or Contractor Si (Signed)_ ----- - ---------- r t 9 } - -------- -- 4 Title -------------- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR. DEPARTMENT USE ONLY APPLICATION ACCEPTED BY " /C- DATE------- ---------------------- , �-. G ----------------------- REVIEWEDBY------------------------------------- ------- ---------------- --- -------- -- DATE --------- - ------ ---------- --------- BUlLD1NG PERMIT ISSUED - �/ - --- �� 6 -- - -- ---------- - ---------- Alterations and/or recommend ations:------- Q-�._�l-."- ------------- - ------------------------------ Dater--- � � - ------------- / i P - FINAL INSPECTION BY-------- ---- --- -----------------=-- ------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT `1401 E.Nazetton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Staekton,California F.P.C W.