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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) I Health District for a permit to construct and -install the work herein described. Application is hereby made to the San Joaquin Loca inance No. 549. This application is made in compliance'with County Ord _ JOB ADDRESS AND LOCATION----------------- oZ Phone------�2 'Zr"'-------- /� �- I--------- ------------- ---------------------------- Owner's Name-----------------• j',f----- '' =t = = ------------ Address__. D 1'� ------Q j)_ ------------- ----------------- Contractor's Name------------------------------------------- ------------------------------------- ----------------------- � Motel Other r Installation will serve: Residence 0 Apartment House ❑ Cc 'merc;al ❑ Tra,ler Court ❑ ❑ 7 s------- f Number of living units: ❑ Number of bedrooms ® Number of baths. � Lot size____ _______ Water Supply: Public system Community system ElPrivate ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam [IClay Loam C3 Clay [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well_________________Distance from fqundatis'nzQ-.—"_----------Material.Liquid depth______-_ _i______------ _______ Capacity No.Distance from nearest well________ of compartments---=---------- � y��--_- ----.-----. �� ---- Size: Diameter--------------a---- - Depth / ---------- ------------------ Privy: Distance from nearest well_____--_________________ ---------------- l_-�---Distance from nearest building------------------------------------------ Privy: ---------------------- . ❑ Distance to nearest lot line--------------------------------- - Seepage Pit: Distance to nearest well----------------------Distance from foundation________________.--.Distance to nearest lot line________.________ Number of pits Lining material----------------- ----Size: Diameter-----------------------.Depth El Disposal Field: „Distance from nearest well _ DLength ofistance re ch l ne_atian _ Width oftfrec hest-lot line---------------- F . Number of lines---------------------------------- Type of filter material--------------------------Depth of filter material___--------___---_--- s`� --------- k7 and/o� repairing (describa�------------------------ t------------- Remodeling - 77Y . �-�� _ ----------- ------------Y� " - ---------- --------- � --------------------------------------- ------------- - - -- -- - -------- -- 1 hereby certify that I have pendareduthisoap application the San Joaquin hLocal workHeall Health }��}� accordance with San Joaquin County ordinances, State laws, and rules I 9 Y ��+ x (Owner and/or Contractor) r (Signed) Title I (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application . FOR DEPARTMENT USE ONLY ------- DATE-------------- ?�s1 v APPLICATION ACCEPTED BY------------------------------------------------ ---------------- DATE----------� -------------------- REVIEWED BY------------------------------------------------------- -------------------- ------------•� -�1------------------------- ----------------------- DAT ------------------ -----------•------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------- ------------------------- -----•---------------------------------------------------- --------------- Al+erations and/or recommen ations______________________- ---_-----__________________ -------=--------- ------------------------------ --------------------------------------- `----------------- ------------------------------------ ------ 1 � / ---- - - -------- - D � 5 ---- ((Date) INSPECTION BY:. PERMIT __.--_-- ISSUE . e -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-4-2M 4-So W-1634