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FOR OFFICE-US : , p f it' No ----- -- -- - - •----- APPLICATION FnR SANITATION PERMIT -f________________._____.___._ (Complete in Duplicate) Date Issued ______________________ M. This Permit Ex fires 1 Year From Date Issued lica#ion is hereby made to the San Joaquin Local Health District for o a Permit to construct and install the work herein describe . This application is made in compliance with County Ordinance {�' _1. _C__.'Y�_____________________________________________•__--_---_-----_-----•_.__---_.----_.__-_..__-___------------..-_--- JOB ADDRESS AND LOCATION_-..:�� ----� 4 Phone------------ t1�1- ----------- -------•-------- :__...✓Y� _ vt• Owner's Name-- .................................................... --•----------•--------------- Address-_ J4 - one---------------- --•--•-•--------- - .� - I -. •-------•----- Contractor s Name--------- Motel ❑ Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑6`0 x 1_.� Number of living unit's: ._._._ Number of bedrooms —2___ Number of baths _:1._._ Lot size ---_------------- Private ❑ Depth to Water Table,-IT. ft. Water Supply: Public system E]Community system ❑ Adobe Hardpan ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay❑ Character of soil to a depth of 3 feet: Sand ❑ G ❑ New Cons#ruction: Yes ["o ❑ FHA/VA: Yes [3 No ❑� Previous Application Made: (!f yes,date--------------------) No [ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi��,T,ank' Distance from nearest well-----------------Distance from foundatin de th_ Materia:----:---Capacity...........---- --- pt � / No.,of compartments--------------------------Size----------------------•--•-- Liquid ,P Distance from nearest well_ 2°�`=F� Distance from foundation_,- �-+---:----:�'�t�aft+ren hest i�li��_.'�J....... Disposal Fiel �;.,� - ---Len Length of each line___-___ � 1 1 Number of lines..__..----�..--••-- g Depth of filter material.___•--/-> ---- Total length..---- 0-• • Type offilter materia.��:1. -�----•�- P \ See Pit-- Distance to nearest well______________________Distance from foundation....................Distance to nearest lot line._::-..:------: m ---------.Size: Diameter------------------------- F A 1 Number of pi#s--••---•--•---• Lining material--e Distance from nearest well--------------••-Distance from foundation-------------------- material.._.__...--.------•---•------'---els, Cesspool: ---_De Depth --Liquid Capacity----------------------------g r ❑ Size: Diameter--------- ---- P \I� Distance from nearest building----------------------------------------- Privy: Distance from nearest well---------•------•------------------- ------ ------------•-------•------•------- Distance to nearest lot line----------------0 1 [ f or repairing describe) _ ---•---•---•----------- 1 Remodeling.:and/ P 9 ' ��u% - ----------•-------------- � - ------------- Lt9l;/f/� _✓k4_.n .._..-- --------------------------------------------------------------------•-----.........................•--------------------- -•- I hereby certify that 1 have preps fQd + is application and that the work will be done in accordance with San Joaquin County ordinances, Sfa+e laws, and V gu atians of the San Joaquin Local Health District. -------------------------------------------- (Signed) -----------(Owner and/or Contractor) - - = �I Title BY= --- --. ----------- (Plot plan, showing sire of lof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------ --------- - :_��= ;-! DATE--- ------------- ------- ��-fJ APPLICATION ACCEPTED BY ---- DATE REVIEWED BY---- --------------------------------w------------ - --------------•------•------•--•----------- - BUILDINGPERMIT ISSUED.-----•----•---•-------•-----•-------------•--------------••------ ---------- ---------•------------•-------••-------•-•-----------•------------- Alterations and/or recommendations:--._.___------------------- ..-----.-----------------............ FINAL INSPECTION BY:-.C.... ...... .._ 's...... ------ --------------- Date------[-�--"-•l--'�--�--�-�•----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 130 South American Street 300 VyeH Oak nrnet Tracy,California Stockton,California Loll,California Manteca,California pa 0 Sje VISCh a-S9 21 5-61 ATLAS 4 r.T