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{ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ----------------------- JOB ADDRESS AND LOCATION------------23-52---- -'-------Flora--------- ----- ------------------- - ---------- Phone----]C1S1----- ------ - Owner's Name. IQ L ,e ----------------- , --------------------- Address--------------------•----•-- Phone 3" 9-5 ------- ------------------------ Contractor's Name_------1.e-1ta------•-----•-------------------------"------ -------- ------------- Motel Other ® C,.af Installation will serve: Residence ❑ C]-Apartment House Commercial ❑ Trailer Court ❑ ❑ ' Lot size-- -------- Z.QQ--------•------------------------- Water ------ -------- ------ Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ 75 Community system ❑ Private ❑ Water Supply: Public system ® Y Y Adobes Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel F-1 Sandy Loam ElClay Loam❑ Clay ❑ i Y h + A. TYPE OF INSTALLATION AND SPECIFICATIONS: . [No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Dia ance+om foundation____._______--___-_-Material_ (quid depth______________________-. Capacity ------Size-------•-------- --- - ❑ No. of compartments------------------------ - Cesspool: Distance from nearest well_________________Distance from foundation____.______.______.Lining material-________.-___--__--- Size: Diameter--------------------------- ❑ --De th-------------------------- -------------------= :Privy: Distance from nearest- well___-______"__________________ _- _-----"_----Distance from nearest building----------------------------- -- ❑ Distance to nearest lot line------------------------------------------------ See age Pit: Distance to nearest well-_?3brl _____--Distance from foundation__--a-Ql-"'.___Distance to nearest lot line___ l4-------- p ate: Diameter 4� .Depth__-0 ----------- ------ Number of pits---------]---------- g Linin material Field: Distance from nearest well------------------ from found 'Z on _-_______ _-Distance to nearest lot line___._________.___ 3 DisposalE---Width of trench----------------------------------- 1 ❑ Number of lines---•-------------------------------Length of each line-------------------- Type of filter material--------_----------------Depth of filter material-------------------- ------------•----------•--------------------------- ----------------------------------------- Remodeling and/or repairing (describe):--------------re,�air_1nF_--------------- ---------------- --------------- ----- t ____________________________________ ____._____ _________________________________________________________ ________ -----------------_----------_ 1 hereby certify that 1 have prepared and this a olf the San Joaquin Local HealthDistrict.Di tr ctdone n accordance with San Joaquin County ordinances, State laws, 1 3T 1G _ . -- --------------------(Owner and/or Contractor) --- --- -- (Signed)------- I lt_a__3S_ep_41�--- - (Title)------pw�ger4l - ------------ -------------------- ---------(Plot plans, showing size of to+, location of system' re i n:to w s, buildings, etc., must be filed with this application. f FOR DEPARTMENT USE ONLY 1 DATE--------- - - � ems------___47------------ APPLICATION ACCEPTED BY____ __f--}-- -- l-- E `w DATE------------------------------------------ -------------- BY------------------------------------- ------- -------------------- REVIEWED DATE. BUILDING PERMIT ----------- ISSUED .. ----------------•----------------- ------------------ Alterations and/or recommendations_______________"--- -------------------- ------------------ ---------------------- ---------------r-------- -------------------------------- ------ j Date FINAL INSPECTION BY:.- �----- PERMIT No._ - -------- ISSUED j I Date---------- --------- ---------- SAN ------ JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street w Stockton, California ES-9-2M 9-50 W-1639