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\J,, Permit No'. -- + -APPLICATION�-FOR-'SANITATION PERMIT [,� (Complete in Duplicate) / 'v Date lssuedE - ------ } rApplication is herebymade ti -fhe an Joaquin LocaIwHealth District for a permit o construct and'inst l �h rk herein described. This application is made in compliance with County OrdinaInce ISIS. 549, �ly f �- --------- "C .. C TI"trN w. ; -JOB'ADDRES$ AND OO � Phone _ ------ ------------ ------- Owner's'Nane---- z -••--•------------------- �d __ _Addr ss- = f Phone -'+ - - ------- � ` _ Contractor's Name---------------------•------•-- Motel E] Other El serve: Residence p ent House ❑ Commercial El Trailer Court [I / Number of baths .�--- Lo�. Lot size __ - -••--- b Numbe'7 mr eof living units: --__ I<lur of bedrooms,.-. I r rt. Depth to Water Table ft- Wate Supply: Public system Community system ❑ Private ❑ p Character of sail to a depth of'. feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 1 1. Previo us Application Made: Y's ❑ No New Construction: Yes No ❑ TYPt OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well-----------------Distance from foundation..--..-_-....1-._...Material_-..-___...--___.- ---------------------- No. of comp artments--------------------------Size-----••----------------- ------ Liquid depth Capacity . ,� )p Disp> •Field,: r istance-from nearest well..................Distance from foundation------------- ..-_.Distance to nearest lot line.._-._...-_....- tna i�f�i Number of lines-------------- ------Length of each line--------------------- - --Width of trench- YY aterial =_':=:'! Total length----------••----•------------------------- �1 Type or filter material-------- --------- p ilter m - __....-De th of f See a e Pit: Distance to nearest well ._ z_ - ss ante from foundation-.-_-------- See to nearest lot�ine _�__...--- U � t p �- 1`' Lining mater Ll Size``Diameter----•�----- ------ Dept'n 4 Number of,pits_. U W / ! Cesspool: Distance from nearest well...._.__.___.. Distance from foundation................... Lining material------------------------------------- . ❑ Size: Diameter-------------------------- Depth_: ----------------------------------------------- Liquid Capacity gals. Privy: Distance fr m nearest well-_.....-'---_._.ti '_ ..-----Distance from nearest building---------------------------------_..._ ---------------- 4 ------------------------------------------------------ -- ---------------------------------------------r+ - ❑ Distance to nearest lot line---------------=--------------`f===•-------•---------------•-"------ E � r . .! � /',ill----------- ---�`•-----•�---•----- ------------•-----------------•-•------ ---------:--•-• .�. Remodeling and/or repairing (describe)_- f_--�---- # # I r ----------------------- ----------------- --------------------- ---------------------•------------- -------------------- --------------- ---- _. -------------------------------------------- ----------------------------------------------------------------•------------•------------------------------ ----------------------------------- A -------------------------------------------------------------------------------------------- - = ------------t------------------------- -- I hereby certify that I hove prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law rand rules and regulations of the San Joaquin Local Health District. i ----------------- --- ----•------------------- � " = (Ownert"ad/or Contractor) -•'t SY� r `s ---- - --------------------------•----------- -------- (Title) — --------------- ------------- -------------- ='_�— (Plot plan, showing size of l +, location of system in relation to wells, buildings, etc., can 6e,placed on reverse sid FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED' BY------ DATE----------------------------------------------,------- ----------------- -------------- REVIEWED BY- --------------- - - DATE---------------•--------------- ----------------------------- ------------------------------------------------- 0 BUILDING PERMIT ISSUED Z------- '------------------------------------------------------------------- Alterations -------- ----------------------------------------- Al+era+ions and/or recomm ndations:----=----- -------- ------------- --------- --------------------------------------------•---•-----------------------•--------------------------------------- ----------------•---•---------------------------------- -- ---------------------------------------------------------------------- - ------------------------------------------------------------------------ ------------- ------ ------------=- -- ------------------------------ ----------- ------------ ------------------------" ------------------ - - ----"----------------------------------�-------- Date---------- -------�^--------- ------------------------------------- FINAL INSPECTION BY:----------------------- - - ----------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West OA Street 132 Sycamore Street 814 North "C' Street 130 South American Street Trac California Stockton,`�California Lodi, California Manteca, California Y. ..r GC-4—TM io-52 Revised W-2100