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Permit No. No. ..3 EOR SANITATION PERMIT APPLICATION t ��`+0 (Complete in Duplicate) Date Issued ----------------------- Applica*ion is hereby made to the San Joaquin Local Health Dist 5fo a permit to construct and the wok herein This application is made in compliance with County d7L CZ JOB ADDRESS AND LOGATION_._ �-'+14xexA �y, --------------------------- Owner's -------------------Owner's Name---------------A1-11.c-------a.-a.}-------- --- Address .--------Rlwv.....(q ?�f 'J e .... -.---- --- --- ---=--- Ph e _ _C1----- �` �? ------------------------------ Contractor's Name_.-.--_-. 11G- Motel Other ❑ Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: __./_". Number of bedrooms _ Number of baths ... Lot size .__ ." Communitysystem ❑ Private �epth to Water Table -------- ft. Water Supply: Public system 171 y Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam El Clay Loam [Iy❑ ❑o New Construction: Yes ❑ 11 110ti Previous Application Made: Yes ❑ N No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)� ' (� � Distance from #oithin 0 feet.) ------Material. C1t_a_ _dry ' Distance from nearest well_. [ --- — si P tyy�'� ,41 .. tic T : -11 aG No. of compartments...�u__-"_.............Size��'.`�-�j�-�---Liquid depth ..�--- ---- ------Ca as - - 6 31, -------- from foundation_______________ Distance to nearest of line----------------- Distance from nearest well--___-.-_-----_Distance spos�l Length of each line------------------------------Width of trench ---._-------------------------- Number of lines------------------- •---------- g Type of filter materia.....--__--.---_---_-_-.Depth of filter material-----------------------Total length------------------------------------------ page Distance to nearest well----------------------Distance from foundation...ameter------------------------Distance to nearest lot line---------------- Number of pits"_""_""__-"".- _Lining material.. _ ---- Distance from nearest well----------------- from foundation"-_---------------:Lining materia. ------ --- Cesspool: ."_.Li-.Liquid Capacity gals. --Di Depth---,-- q P y----------------- ❑ Size: Diameter--------------------------------- p "__"•_:__"_________.__"_Distance from nearest building".__-_----------------------------------- Privy: Distance from nearest well "__. ------ ---__-_---_______-- ❑ Distance to nearest lot line_--_---"--"_._.""""-- -..---------•----------------------------------------- Remodeling and/or repairing (describe):--------------------------•---------------------•-----------------------------------------------•------------------------------------•-------- ---------•-•---------•-•--•-------------•----•----•------ ------- I hereby--cert'---- P P y 1 have re ..red this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws, ..n rules nd regulations of the San Joaquin L al Health District. I— xvjAcw Contractor) ------------------- tj (Signed). " ------------------------ 104 BY:•-•------------•--------•------------•--•--------------------------------------- (Plot plan, showing size of lot, location of system in relat' n to wells, buil ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------- DATE_�--------------- ---- ---------- ------ - -- --------- ••-----••••------ DATE • .................. REVIEWED BY...............- ---•••••. DATE--------••- BUILDING PERMIT ISSUED------- ------ -------------------------------------------- - . Alterations and/or recommendations:----------------- -- ....................................................... ---•---...........................--------------------------------------------------------------------------------------------- - ._........-•--•-•------• - -- ----- ----------/ FINAL INSPECTION BY:''�t�t�'"�--------------------- ----- Date... r SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised W-2100 1