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APPLICATION FOR SANITATION PERMIT Permit No, \ 5 (Complete in Duplicate) Date Issued Applica"ion 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 Ordnance No. 549. _ `. 1�) . t3----------- ----- JOB ADDRESS AND LOCATION----._ - - Ph Owner's Name-------- _ a e -------------------------- Owner's ----------------------- one `.'� - �- - Address----=----••----------- ; ----- ----------�-------------------------------------------------------•-------------o-------p - - --- } --------------------------------------------------- Ph Contractor's Name----- �� c . . • - - - • Motel Other ❑ Installation will serve: 4Residencre Aparfinent'Housd ❑' Commercial ❑` Trailer Court ❑ - `❑ Number of living units: __1__-- Number of bedrooms ._�----:Number of baths __r/--- Lot.size _�-�----�--1�----------------------•- Water Supply: Public-system-VfiCo muriity system ❑ Private ❑" Depth to Water Table Oft. Character of soil to a depth of 3 feet: "Sand E] Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ NNConstruction: Yes El . No ❑5, /V Previous Application Made: Yes ED ;o( ` ew TYPE OF IN AND SPECIFICATIONS: (No septic tanVor cesspool permitted if public sewer.is available within 200 feet.) Se tic,1PTS nfk'Y:l from foundation___.________.-:----.Matena _-�_ -Distance from nearest well_______________:Distance Capacity-.___________---------- ----Size----------------------------•---Liquid depth--------------------------- No. of compartments-------------- - Disposal Field: Distance from nearest well._,_____________°Qistance from foundat.ion_____-_______ _-...Distance to nearest loft line----------------- �StI�G� Number of lines---------------------------------.Length of each line---------------------------:-.Width of trench..___'--------------- - fih of fil}er material-----------------------Total length-------•---------------------- Type of filter materia4________________________ p l I- — _. -- -- t - Distance to nearest lot line_ .__ __ See age Pit '-" "Distance to neares well- -0-14-�-Distance fr if ndation__.�i -_-___--. _ r� W l Size: Diameter �------- Number -- Depth a -------------•--- } number of its-------1---------- ------ - - -Lining material-_ - _ r +l p I cesspool: Distance from nearest well__-! ______ -----Distance from foundation____________________Lin"sng material------------------------------------- -- . . l p _ Depth------------`----r---------------------- Liquid Capacity =� gals. -n ❑ Size: Diameter--------.-=--L. = F _ 1T p. _ t - -----------Distance from nearest building ---------------------- ---- -- Privy:i Distance from nearest Well -------------- -- - ------ , . ----- , • �- —' Distance to,nearest•lot,ljnerv._-__.�'��-'"'=---- - !. ❑. • - repairing• � �-1;"'•' by y -[ - •..w _ ----- r g - { } ---- ----------=-------•----•--------•---------__---.--•----- Remodelin and/or descri a : __- -_.___;-_____ - i ---------=------------------------- ;-----------------------•,-----------------------------�------- ----------------------------- ---------- ' ----------•---------------------------------------- ------------------------------------------------------------ i. ! hereby tify that I have prepared.this application and that the work will be done 'in accordance with San'Joaquin County ordinances, at .I-rules regulations of the San Joaquin Local Health District. I ' ( Contractor) 1 ------------ (signed}_ 1�. 1 -'_- ---------------= - 4 or r - - � _• � _ _ -----------------{Title- ---� �__Q=x------ --------------------- By ------------ # sY� --------------------• - -- (Plot plan, showing size of lot, location of system in relat on to wells, buildin s, etc., can be placed on reverse side)._ FOR DEPARTMENT USE ONLY z DATE-----------• �3 APPLICATION ACCEPTED BY------------------------ -------.------------- _ ------------------ DATE------------------------ ------------- ------------- REVIEWED BY--------------------------- --------------- - BUILDING PERMIT ISSUED_--------•--------=--------------------------- - -- DATE ,---------------------- --------- --- ' --J.----------- . Alterations and/or-recommendations:__-#_-.-- s -- ------------ ---•------ __________________________ I r 1 __________________________________ ___________________________ ______ f e ----------------------------------------- ------ . ---•---------------- -----,------ ---- --------- ------ t . 1 a 1 ^ " !� . -----=----. Date-=----------------=-=-- -------� --------- ----_------- -------------------•---• FINAL INSPECTION-BY:- ---y-.---n SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street !30 South American Street Manteca, California Tracy, California Stockton, California Lodi, California FS-9-2 M Revised W-2100