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FOR OFFICE USE: •� ---- -- -- ------ ----- ------ - - Permit No. .T.1-Q S� ----- ------------- " - APPLICATION FO1t-SANITATION PERMIT -------------------------------------- ----------------- - (Complete in Duplicate) Date Issued __ __��-•-- 6 ------- ---------------Al--------- ._.�" _. This Permit I:x ires 1 Year From Date issued Application is hereby made to the San .Joaquin Local Health District for a permit to construct and instai4 the work herein described. This application is made in compliance wC149 u rd ce 5�� „ /,��•MI ` T --------------------------------------- ADDRESS A O ATI -- -- ------`-------------------'�-------------- JOBy��11 ------. .. Phone ------•------------------------ Owner's Name------- -_ _r "1----- -- - ------------------- - F Address----------•------------------ i. one_. Contractor's•Name,_____ --- -- V � Motel Other�� Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ ❑ Number of baths 1----- Lot size _--� Number of living units: ___1"-- Number of bedrooms _ __._� Community system ❑ Private [Depth to Water Table -------- ft. t+ Water Supply: Public system ❑ y y Adobe❑ Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam ❑ Clay y Loam ❑ Cla y ❑FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date--------------------) No F1 New Construction: Yes F1 No ❑ s TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well-__S�-r----Distance fro foundation /V Material--.. - -------------------�---/--- Li uid de th___. _`---------------Capacity---rF-gv No. of compartments.------7r--""--- Sizer----- --g----X q p. m Dis osa Field: Distance from nearest well-J�p�-------Distance from foundation__J C-- ------Distance to nearest lot line�---- ---- p t Length of each line------ p Width of trench.-- -�j.. Number of lines------------ lV r Type of filter matenal____.___�-_�-'-----Depth of filter matenaL___/_�--°--------dotal length___. _.O_�-=----- -------- -------- r t - 0 �• t Depth_... .'S'. Seepa Pit:: Distance to nearest well-_._1"---��----- -Distance from foundation__-"�_D-"_--"___.Distance to nearest o me--- ----------•- NLT -umber of pits________��---�Lining material__5._`�'-'------Size: Diameter._.._`,, --- 3 I _______________ Lining weI __--__. _-Distance from foundation_ gals Cesspool: Distance from nearest .__ -_-Liquid CapacitY--- ----------------------- Size: Diameter---- - ------------------- Depth ❑ - Distance from nearest buiHing----------------------------------------- Privy: Distance from nearest well--z--------------------------- --------------- --- ----------------------- ------------ - ------------------------------- ❑ Distance to nearest lot ine--------------- --- --- --- � ==-------------------------------------- Remodeling and/or repairing (describe):-- - --- ---------------------------- ---------------------------------------------------------------------------------------------------------------------- i + I hereby certify that I have prepared this applications and that the work will be done in accordance with San Joaquin County ordinances, State l s, and rules and regulations of the San Joaquin Local H�alth District. Si ned and/or"Cortitracter)" 44 --- --- --------------------------------- - - . -- -- ---.. )..------ ------- - ---------6 ------(Tit e---------------------------- --------------- [Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - '� - - - - - --- -�-- ------ -------- ---------------------------- DATE._. ----------- ---...- - --------------------------- APPLICATION ACCEPTED BY_; !�-- DATE-- ---------------------------- ------------------------- REVIEWED BY------------------------------------------------------------------------------------------------ -------- - ---- ---------------------- ------- ------- - DATE-- ------- ------- -------- ----------------------------- BUILDING ----- ----------------- -- BUILDINGPERMIT ISSUED---------------------------------- -------------- - ------------------------------------ ------------------- Alterations and/or recommendations .................. - ------ ---------------- ------• ------------------------------------------------------------------ i FINAL INSPECTION BY:. �. ---------------- Date. --------------------- �� `° SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California :_•f••--- .:.- Manteca,California Tracy,California F.P.CO.