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FOR OFFI UA: --- ------- / '� - APPLICATION FOR SANITATION PERMIT Permit No. ./ ............: --- ------------------ (Complete in Duplicate) ----------- �.- -....___---_..__.._.. This Permit Expires I Year From Date Issued Date Issued -------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with hhjjCounty Ordinance No. 549. JOB ADDRESS A t C T�ON �iG--- - -- �/� ' Name , ---------------------•------.----------------------------------------------•--- Phone-40-1.5'a.- Owners ---- ----- Address-------------- ----- L-9�-/1 A -�--- ----- ,` / -`- Contrac+or s Name . ' ._ 1tR�__ / ,,j --------.... Phone-�f�1------fes_ 'T� -ler Court Motel Other ❑ Installation will serve: Residence partment House ❑ Commercial ❑ Trai ❑ ❑ Number of living units: _�-___ Number of bedrooms u Number of baths __ of size f _.`..? __.l d________________ Water Supply: Public system Community system.❑ Private ❑ Depth To Water Tableld�i;)- ft. a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ a Previous Application Made: (If yes,date--_.__-------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic or cesspool permitted if public sewer is e _ available within 200 feetA .) k- Distance from nearest well_-_-______ _--__Distance from foundation--------------------Material------------------------------------------------- No. _____________.___-- .-_-___---------__-_____.No. of compartments--------------------------Size--•--------•--------------------Liquid depth--------------------------Capacity---------•------------- Field: Distance from nearest well-A-ame.._Distance from foundation----.-l?_r-...Distance to nearest lot line___l.Q Number of lines------/____ __-.---_ ---- Length of each ---------Width of trench°'_________-`---- d Type of filter material ` _ Depth of filter material___.-- -Total length----_.......... _______ e-0...---•-- Seeps a Pit: Distance to nearest well----f.1joAje----Distance from foundation____-_ �J. .Distance to nearest lot line_ Number of its__-_ _ _______Linin material_1c. __-._-Size: Diameter___ . -` _.___Depth.._.`�e '............... �r P 9 ( • Cesspool: Distance from nearest well-----------------Distance from foundation-__.---------------.Lining material------------------------------------- - W ❑ Size: Diameter--------•-----------------------------Depth_--------------------------------------------------Liquid Capacity----------------------------gals. Privy:: Distance from nearest well-------------_-----------------------------------Distance from nearest building______.________--_____________-_----_--_-. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------ ------- ------ - -----•----------'----------•------------•./.�---�-J--'----- -------------- -----------------------------••--------- -------------------------------------------------------------- �� ------------- •`-- •- ----- ----------------- »--- ---------------------------------•- --------------------------------------/I/------------------------------------------ hereby certif that I a prepared this application and that the work i be done in ac ordance with San Joaquin County ordinances, I d rule nd regullations of the San Joaqu o alth District. k� [Signe .. [�"nrroa Contractor) Y� -•------------ -- - - - ------(Title)-------------------------- ...................... (Plot plan, showing size of lot, location of system in relay to wells, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----. t-------- -- -- -- DATE-------z ._-------- z REVIEWEDBY---------------------------- ----- ----------------------------------------------------------- ••-------------------- DATE--------- ........ ------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------- ----------- DATE...-----•----------- ---•-------------------------•-------- Alterati ns and/or recornmendatio s:__._.` 2'� c � �`'/-----`Z�=p�Z l .............................' '' f - G,, n� _l L G/ = C3-r.-GGA' t c /� - —r'` e --�CG�t-- _-- r ��- -----4- ---•--•i-------- -------t------ 4 --------------- ----- -------- ........ �c ` f ----- ------•--•-------- ----------------- -------------------------------------------------------------- -------------------•------------.........------------------------------• - - ----------------- ----------•- ._ ---------- l �/Date------- ;e FINAL INSPECTION BY: _ . . --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California i E5 9 REWSED a-59 2M 5-62 ATLAS ,