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=ixti FOR OFFICE USE: __---._--_-----_ APPLICATION FOR SANITATION PERMIT, Permit No. .._... .-.. . -------------- ---------------------------------------- (Complete in Duplicate) Date Issued 2-S -_-------_--._._--._-- This Permit Expires 1 Year From Date Issyed _____ __________//.___ Application is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compliancewith County Ordinance No. 549. /1✓1T�� r JOB ADDRESS A TIO ---- - --------------'I --------------- - - - - --- ------ Phone------------------------------------ Name Owner's � - x ,1-1 � =Address------- --"- .. - . ---•-------�� Contractor's Name-------.------------s r ----------------•---------- -------------------- ----------•--•----"----••------- ------ Phone----------------------------------- Motel will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer C/able FMotel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths _-__-._ Lo _--_, a-_X__. /S _-___-_"---..---_"- Water Supply: Public system ❑ Community system ❑ Private Depth to Wa7am 16-_ ft., Character of soil to a depth of 3 feet: Sand (Gravel ❑ Sandy Loam P_�Clay ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------.- --------- ) No [T' New Construction: ;Wes [r-No, FHA/VA: Yes E] No n— TYPE OF INSTALLATION AND SPECIFICATIONS: 11 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-'-5-.O....... Distance from foundation---- _._-.._.Material --- ----------------------_ ------------------ U3__ _ .-. --_---_.U3_ No. of compartments-.-..2----------------Size--- Liquid depth----------%.___---------Capacity_.l�u.�. Disposal Field: Distance from nearest well.tj__B--r-.--_Distance from foundation.CQ..!_...__._.Distance to nearest lot Number of lines-.____"_1--------------------- -Length of each line—AnoWidth of trench---!9F ------.-.__-____ Type of filter material_:__.�'_�__P_C_k_----_Depth of filter material_-- ----------Total length---A6?0___`___"--"____-_--______-- Seepage Pit: Distance to nearest well_-__.---------------Distance from foundation--------------------Distance to nearest lot line__-------------- ❑ Number of pits---------- -----------Lining material-_---. --- ------------Size: Diameter-----------.-- --------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------__-_."_-_._-.-___. ❑ Size: Diameter"-----------------------------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------_..--.Distance from nearest building------ --------------------------------_. (� ❑ Distance to nearest lot line------ --------------------------- --------- ----------------------------•---------------------------------------------------- ------------- (�\\ Remodelingand/or repairing (describe):------------- ------- --------------------------•-----------------------------------------------•-----------------•-•---------------------•----------- ---------- -----•---------------------------------------------------------------- -------------------------------•---------------------------------------------------•------------------------------------------------- ---------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------•-•---------------------------------------------------- --------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws nd rules and reg lations of the San Joaquin Local Health District. ---------------- c-------- -- -- ---- - --------------------- -----------------------_-------------------------------------------------(Owner and/or Contractor) (Signed) By:----------------------------------------------------- -----------------------------------------------------------------------------(Title)------ -------------------------- ---- ------------- (Plot plan, showing size of lot, location of system in rela `to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY-------- �FLR `��-- --•---- -------------------------------- DATE--------- - �� — REVIEWEDBY--------- --- -------- -------------------------------- -------------------------------- DATE-------------------------------------------------....------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ --------------------"- DATE-------------------------------------------------------- Alterationsand/or recommendations:-..-------_---- --------------------------------------------------------------------------------------------------------------"-•--""-------"-.------------. ----------- --------------------------------------------------------------------------------------- ------------------------------------------------------ -----------------------------------............................ ------------------------------------------------------------- --------------------------------------------------------------------------------•---------------------------------------------------------------------- ------------------------- --------------------------------- ----- ----------------------------------------------------------------- -------- ----------------------- --------- ----------------------------------------- -� -------------------------•-•----------•----------------------------------------------------------------------- FINAL INSPECTI BY ,� K_6L7;�,7Date------- ------1�.-.:_ 15 - ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.