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w FOR OFFICE USE: � f� _ -------- -------- ' _6.. i ' "-- ------------ ---'-- ----------- - APPLICATION FOR SANITATION PERMIT Permit Na. . ......: . = _ (Camplete•in Duplicate) Date Issued ---�_- ----- - - ....... ---------- -- -- This Permit Expires 1 Year From Date Issued 2_W —C" _C't# ein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h r This application is made incompliance.with County Ordinance No. 549.I 1 01 v2nE Ar -------j JOB ADDRESS ANJ LOCATVOp� p . Owner's Nam - ------ --- - ------- Phone ��_f_ I t r �''' qe4 �`� _ CJS ,--=-- �_ '.i.Pd+ .� Address_ _....____ -•----- Ir -----------. Phone------ ------------------- ------- Contractor's Name_.. ' ' Motel Other Installation will serve: Residence ❑ Apartment House ❑ Commercial [ Treiler Court'❑ ❑ ❑ i ...... Number of living units: """_ Number of bedrooms"""" _._ Number of baths'-""""-i Lot size _._ _t-��-E Water Supply: Public system Community sys m ❑i Private [ rIDepth fo Water Table__..__ _ ft [I Character of soil to a depth of 3 feet Sand Gravel ❑ 'Sa,dy Loam.❑ Clay.Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ - `1; Previous Application Made: [If yes date_...-... ----- --- N' New Construction: YeseNo ❑ .FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND .SPECIFICATIONS: a �' l k (No septic tank or cesspool permitted if public sewer is available within 200 feet) ; 4;j Mater ateral --- - -------o —Distance from"nearest welL____..7" _ Istance from foundatn ._ _ Septic T _ - _.. No. of compartments-----.. - ""-- S .:_-"- ---'-'---L�qusep __ Capacity. _ - 4 Disposal Field: Distance from nearest well:- .. -____._Distance from foundation________-----------Distance to nearest lot line----------------- ❑ Number of lines. ----------- -- -Lerigth,.of each line-- ---`—-------------------.Width of trench Type of filter material.................. . Depth cof filter material----------------------- Total length-------.------------..•------------------ . � Seepage Pit: Distance to nearest well._-� a..._--Distance rom foundation_.__."� ""--.Distant +o nearest lot line_.__r..______.._ T( Number of itsk-. Lining material__ -r Size: Diameter.=� _ .._ __.Depth_..__ _ "c----------------- p ----------- r s -� Cesspool: Distance from nearest well ________________Distance from fGndation__..______.__-- Lining material_i_'_.__.----------------------------- Cesspool: ' gals. ❑ Size: Diameter- -- ----------- -- -------- ------Depth--------------'-------------o---'.- --'- -- Liquid Capacity ----------- -------------- S I Privy: Distance frominearest well---------------------':-----_-----==-'` F= -Dist ii e� from nearest building-------------------- -------------------- Privy: --- F1-- .-- _ .__._.._ _______________ I ❑ Distance to nearest lot line ------------- � 1 r ----- Remodelin and/or repairin j_(describe):- -- � {-C. -M ""1-/ " " °.� } 1A•- ------ A6Wit- �#'1/ T f T" 1--------- ��--- ,�_ £+ `l 19_ -------- ' ' '�------- f '' - ------ ------------ --- ------' ' - - 7--- --- --------------- --------- '----------'--- -'---- I hereby ce• i y av epared this application and that the work will be done in accordance with San Joaquin County I ordinances, S+ a ws, `regei ,t}t_e-.San Joaquin Local Health District. '"' ---- ----- ". G''i '----------------- •- - ------------------------... (Owner and/or Contractor) {Signed)- --- - --'- ---_- -�',�� r'�� •, -------------------------------- ----- ------------- --�(Title) ,--- - - --'}�- (Plo+ plan, showing size of loft, location of system in rela+ion to wells, uildings, ee+c., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------7F " :• L-------------- ----•------------------------------ --------------- DATE------- --- ---------------- . DATE__ BY----------------- ----------------------- ----------- - -----------------' ' ---'------- ---- ------------------------ REVIEWED# BUILDING PERMIT ISSUED--.------_-------------------------- DATE-------- '-'--------'---'= Alterations and/or recommendations:-------'-----_- ----'----- ----------------- ------ ---------------< ; _... ' ' - ----- -------------------- ----.-- --------- --------------•---------•----------- ------ ---- ----------- -----------------------------• --------------------------------------- -- - ---------•---- - -------------------------------- ----- -' .-- -----•------- --- --- --------------- -'---'---' - FINAL INSPECT N BY = Date.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycarrnore-Ureet 205 West 9th Street stockion,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press