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= Permit No. /._ -------- -> .�, . ._ ---_--- APPLICATION FOR SANITATION PERMIT _— e'S� , / (Complete,in Duplicate) k d _ Date Issued --------- This Permit Ex ires 1•Year From Date Issued 1 --- ----------- ------ .. Application is hereby made to the San.Joaquin Local Health District for a permit to construct and=0 is work herein described. This application is made in compliance with County Ordinance No. 549. F �� 51q ----------------------- �F :JOB ADDRESS AN 0CATION... '�''?` Owner's Na e _ Ph ne------------------------•----------- f , + SCC . --•--•----... ----------------------- IAddress--- -- •---------------- -- --- R -��'�'�.�- --_----� L _ -� - }i---i,-----------------------------•-•--- e - - on Contractors Name--- P •----------------••----- L F Motel Other Installation will serve: i Residence ❑ Apartment House ❑ Corhmercial ❑ Trailer ----------- Court ❑ ❑ ❑ Number of living units- ._I-_-- Number of bedrooms_ :Number f baths _ Ot size _.. -- ------ j _-a_ Water Supply: Public system ❑ Community system ❑ Private Depth'toWater Table -------- ft. +� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Loam,❑ Clay Adobe❑ Hardpan El Previous Application Made: {lfyes,date:_r___=__,_.._ I No ❑� New Construction:".Yes ❑ No E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted-if public sewer is available wiithis_200 feet.);- .� i - Ul Septic T k: Distance from nearest well fir ______Distant �rom.�ou2"__Licl`uid a ion ._�.----.-----Ma jrlal______..___ ___.__. ___ .--------- Septic ___ __ - -- Ca acit i No. of compartments-.------4Y ---------Size _ _/.-- depth_.��---------- - Dispos ield: Distance from nearest well --1`"Distance from foundation.._/ _:�._*IDistance to nearest Eat I�e_ � Number of lin es:__.__-___ �3____-;-y__.�__ Length of each line- S____r7. GS�'---Width of trench___ __,__________.._-_-.-- (� I, � r -------- -- _dotal length =d -------------------, Type of filter.ma -- --_Depth of filter material'-'IQ______ Seep/1 eep e Pit: Distance to nearest well-___ dIDistance{fr�om D• ancfe to nearest lot line----r------- Number of pits-------2--------Lining material--- .i----_ -Size:.,Riameter____ - -----Depth.... `r----- - Cesspool: Distance from nearest well-----------------Distance from foundation____:______..:__--.Lining material-.-.------------____-_-.-__--:---'_. Size: Diameter------ ------------------ - _____Depth-------- ---------- ----------------` Liquid Capacity -------------------------gals. ❑ - p � s Privy. .. Distance from nearest well----------------------------------- ------------Distanc from nearest building-------------•----------------------------- ❑ - ----- Distance to nearest lot line----------------------- -----'=-------------- - --------------------------------- - --- Remodeling ------------------------------------- ---------- -----------------: _------------- --- -- ------------------------------------ -- f ---------------------------------------------------------•----------•-------- s + San Joaquin Local Health Distric q ---------------- ----- ----------------------------------------------------- I hereby _ I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and re Ions,of he t{" t ` -- t - - ----------- -------------------- ------------------_--------------- — - (Signed) � _-: d/orContractor) B le] ...... --------- __ __(T- ------------- ---- --------- -- -- - - -- ---- ------ ---- (Plot plan, showing size of lot, location of system in relat n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-..-_ _ __-----____ DATE______ --'� -� �''} REVIEWEDBY---------------------------- -------------------- DATE-------- ------ ----------------------- -------------------- BUILDING PERMIT ISSUED--=---------------- -- -- _ _ ---------------------.- DATE------------------------------------------------------------- Alterations and/or recommendations:-- --------------------------- --- - - ---------------------------••-•------------ ----------------•-------------- -- ---------- 1 x ----• ----------------------------------•- ----------------------- ------------ -------------------------------- FINAL INSPECTION BY: . .- --------- --- Date--.A !" .--•- � k SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street = 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California - E5 9 REVISED B-59 3M 3-•63 F.P.CD.