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APPLICATION FOR SANITATION PERMIT Permit No. _.. -_-3--....1--- (Complete in Duplicate) 4 . �' Date Issued ___. - Applica+ion 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 County Ordinance No. 5 JOB ADDRESS AND LOCAPON_:_ -7 ... ............ - . �8-- -•-------- Phone-------- --------------------------- Owner s ame__ --- ---- - ------ Address. o -� - ... ------------ t -------•-•----- Ph nj Contractor's Name....494----- - Motel [j Other ❑ Installation will serve: Residencepartment House ❑ Commercial r-1 Trailer Court ❑ mber of bedrooms --7---Number of baths . Lot size __.. _._ + "-------------------•- Number of living units: _/- Nu Water Supply: Public system ❑ Comrhunity system ❑ Private UDepth to Water Ta�?Cclay am Cla Loam ❑ Adobe ardpan ❑ i .Gravel Sand Lo ❑ Y Character of soil to a depth of 3 fest: Sand ❑ ❑ Y �.. Previous Application Made: Yes ❑ No g�. �New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we}4------------------Distance from foundation_u-----------th Material_--------"Capacity------'_..._..__ -_.__ _.. No. compa^r",rs1__ -------------------- ize_ ---------------� _-- i ce to nearest lot line____ spasal Field: Di'0 we i ao fou )aC---- -Len th of each line- -----------------:---- Width of trench.------------------------- 4r Number of lines------------------------ g Depth of filter material-----------------------Total length---------------.----•--------------------- Type ---------•------ � Type of filter material-------------------- ---- p _ , `{ a° / Distance to nearest loft line__.________. Seepage Pit: Distance to nearest well_/or%wA ---Distance from foul anon_. _..- -- -• `, Depto •, Number of pits------ --- -=-- ---Lining material A - , ,v:_Size Diameter_ ------. Dept Hing material________________ __ Cesspool: _-_ quid Capacity---------------------- gals. Size: Diameter------------------ -------------------De th----- ---- --..----�--- ,>. ,. L�ri -� -.•�,.�----- -=x Distance from nearest welL________________Distance from foundation_____.---___..__-__. i ❑ � .� t -- .. i1- 1.— :. _----_Distance from nearest building._____.__-- Privy: Distance from nearest well-------------------- --- \ r ❑ Distance to nearest lot ine--------------------------------- -------------- ----- ----------------------- ------------- �1 ------------- 1 k Remodeling and/or repairing {describe): -----•---•-------------------------- ---------------------------------•----------------------- i ----------------------------------------------- ------- ------------•-------•-- ---------------------------------- --------------- 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, and rules and regulations of the San Joaquin Local Health District. " cr /or Contractor] (Signed)---- - - ------.(Title) r - - By:--. (Plot plan, showing size of lot, Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------- ------------------------------- -------- ----- DATE--------- . - --••---------_. DATE------------ --------------------------------------•------ ---------------- ------------------------------- REVIEWED BY--------"-------- "--------- - --- ------------ DATE-------�----------------...---------------------------------- BUILDING ----"---------------- -------------••---------"------------------- -------------- BUILDING PERMIT, 1SSlJED---•- ..................------ -------- -------------- ----------- Alterations and/or recommen itions:__..__.-_----.-------------------_- -------- -- -__-•-_--_-__---•.•-_-_- ---------- ----- `--- -----•--- ---------------------••-----•------ ---- Date--------- -----•------"-------------- FINAL INSPECTION BY:.___t ---------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 014 North "C" Street 130 South American Street � Trac California Stockton, California Lodi, California Manteca, California y� FS-9-2m 145446 ATW60D