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OR OFFICE USE; ------------- P ----- --- -- ---- ------ APPLICATION FOR SANITATION PERMIT 4 ermit No. (Complete in Duplicate) , I --------- ---------- Date Issued ---- ------------ ---k� ----------M E==�=M�mm L This Permit Expires 1 Year From Date Issued' Applica I fion is hereby made to the San Joaquin Local Healf h Dist rict for a' permit to construct and install the work herein described. This application is made in compliance with CountV Ordinance No. 549. 1% JOBADDRESS AND-LOCATION- -----------------------------------t----------------------------------------------------- ----------------------- ----- Owner's - ------ --- Name- Phone------------------------------------ 4 4 4 ------------- -------M------- Address_�_,/tf_ --- - -------------------------------- ------------------------------------------------ ------a-------- - -------------------------- -------------- Pkone.......-------m------------------- Contractor's Name---------- -------- Motel L] Other Ej Installation will serve: Residence Apartment House El Commercial Ej Trailer Court 0 umber Number of living units; of �Irooms'._2-_-_ Number of baths -,/-- Lof-size ----------------------- I I mmunityj',syst6m 0 Private [] Depth to Water table 050:0-4. Water Supply: Public system.We"C"'o f I Character of soil to a depth of 3 feet: Sand 0- G�avel E] Sandy Loam El Clay Loam 9Clay [] Adobe &-ilardpan 0 11 No A— Previous Application Made: (If yes,date ---------M,... I No Ml'o*New Construction: Yes No g�- PHA/V& Yes E] TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank or cesspool permitted if'rp�ublic setwir is available within 200 feet.) Septic Tao: Distance from nearest well__,.-�-------------Distance from foundation--------------------lvlater�al----------------------- ---------------------- 4f r No. of compartments--------- --------------m--------L-.,Liquid dep�h-----------------_m------Capacity.---------------------- J�W If- Distance from ne --Distance from founclat __Distance to r !— ion---A e--- iearest lot line--.15:7 Disposal Fiefd arest well--- --- ---- -------- f each -------------�Wdth of trench_z/ Number of lines------------ Length o 4e: Type of filter material Depth of filter maferiaI___,/ ---!!��-----Total length---Z ------------------------- is ance r-gm fou d f- ------ - --------- TTI teepage Pit: Distance to nearest well------ -------------D' t f a i Xa- *" Distance to nearest lot line_A_/_ - - 'e ,Y-A 'Numbe.r of pits----/--------------Lining mbiferial---eWAe!r#C_ _,Size: Diameter-J"i 'f---------Depth��IW - Distance from nearest .well from fo�jndation--------------------Lining material--------------- ----------------- Cesspool: -----------------Pistance Size: ----------M--------- -------------Liquid Capacity----------------------------gals. -'from ne Privy: Distance aresf well------------m----------------------------- ...Distance from nearest building-------------------------------------- ElDistance to nearest lot line--------- ------------- ---- ---- ----------------------------------- --------------------------------------------------------- Remodeiing and/or repairing-4des�cril:�e):----------- -------- -- --------I----------------------------------------------------- 64- ----------------------M------------ ------------------- -------- ----------------------------------------- ---------------------------------- --------------------------------- ------------ -------------M---------------- ---------------M---------------- ------------------------------------------------------------------- ---------------------------------------------------------------- --------- ----M----------------------------------------------I----------------------------I------------MM------------- --------------- --------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County - I tions f the San Joaquin Local Health District. ordinances, State laws, and ru t les and reqpTi!_ o ---------------tEhvru?;wKdPr Contractor) (Signed,-------- --- ------- --------- By:--------------------m---------_------------M------------------- --- ------------------- --- --- ......... (Plot plan, showing size of lot,".1ocation-of-syste relafion.-fo*wells,-.buildings, etc., can be placed on reverseside). FOR DEPARTMENT USE ONLY -------------- DATE-- ------- - APPLICATION ACCEPTED BY-- --------1�1(/----------- - - - - ---- -------- REVIEWEDBY----------------m--------------- ---------------- --------- ----------------- - -------------------------------------- DATE------ ----------------------------------------------- P MI U 6 -7 11 --- DATE------------------------------m------------------------------- BUILDING PERMIT-ISSUED------------------------------------- ----------------T--------- ----------------------- or omme, io Atferati"n nd e, ns----- ------- - -- ------- --------- -- ons and/or recommendations: I - ------------------- --------------------- -------- --------------efe.,(----------- --- --------------------------------------------M........................... ---------- ------------------------------- ------------------------------------------------------------ ---------------------------I-------------------M------------------------- ------------------------- ---------------- --------------------- -- ---------------M------------------ --------I_M-- M-------- ------------------------------------m----- -I I I----------------------------------------------M-----------T------------- ------------------------------- ----------------M----------- ------------------------------------------------ ------------------------------------------------------------------------------------------- -- -------------------------------- ----------- FINAL INSPECTION BY:--- A�41�11..... -------------------- Dot,.... ---- ---------- 4K; _ SAN JOAOUIN LOCAL'HEALTH,DISTRICT X S�YN, .StrIlrI 1601 E.Hazollon Ave. 300 West 0 k Street 124 amor Let 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEP B-S9 3M 3-'63 F.P.C13,