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PERMIT (Complete Permit No. APPLICATION FOR SANITATION P (Complete in Duplicate) Date Issued ----V/-3r-/5j-- tyy ade to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby m This application is made in compliance with County Ordinance No. 549. ;, I ��} �J -------------------- -- JOB ADDRESS AND *LOATIONA461,1—-30--....04` -- Phone_ =Owners ame------------- I Address------------------ ---- --------------------------------- - - - ------------ Phone ---------------- artme Contractor's Name----------------- ----- -- - ❑-- -------- - Motel Other � Installation will serve: Residence [�p nt House ❑ Commercial ❑ Trailer Court ❑ ❑, ` � �• .9 Number of baths ,�__-_ Lot size �-4-7 --- 1 Number of living units: __-� Number of bedrooms `____ I Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ `Clay Loam ❑ Clay E3 Adobe.Adobe ❑ ❑r No New Construction: Yes ❑ No Previous Application Made: Yes FHA/VA: Yes E] No �� TYPE OF INSTALLATION AND SPECIFICATIONS: II (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Material----------------------------•-•--------------- ptpC nk: Distance from nearest well-----------------Distance from foundation Liquid de th ------------------------Capacity--•-_------------------ No. of compartments---------------------------Size_ 14 / spo 4 Feld• Distance from nbarest well___ -.-Distance from foundation__ D_----__.Distance to nearest lot Ii l_,� "----- �l Length of each line_____ Width of trench _________________ I �� ' - -- Number of lines Type of filter material_-__ ---Depth of filter material_--��-- -------Total length___._, 0------- ---------------•'-- � �-�-�__.Dista�nfce to nearest lot line___---- Seepage it: Distance to nearest well_'____'_-___--Distance fIf jm fou a#ion_____ Depth_.__p + -------------- r V _Linin material___ ize: Diameter___ Number of pits)___------- ----- g 1 1 Cesspool: Distance from nearest well-_'__--____.__-Distance from foundation--_________________Lining material____--____------------------------— Liquid Ca Capacity gals. ❑ Size: Diameter_�----------------------- ------------Depth------------------- - q n y --------------------- i..l °------- ----Distance from nearest building`----------------------------------------- Privy: ------------------- ------ Privy: Distance from nearest wel----------------------------------- ------------------------------------------ Distance to nearest lot ine-----------------------__----__-- , } Remodeling and/or repairing (describe)______________ ` ' _ ---------------•-------------------------------------- . ------- -•---------------------------------------------------------------- ------ :� --------------------- I --------------------------------------------------------------------------------- ; f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County and regulations of the San Joaquin Local Health District. 4 ordinances, State laws, and r le� 5 ( Al,or Contractor) ------- (Signed) ------(Title)---- - ---------- - ----------------- -- By----------------------------------------- ' (Plot plan, showing size of lot, location of s min relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY DATE------------------- - ------------------ ------- -- -------------------- II APPLICATION ACCEPTED BY----------------------------------------- ------------ DATE------------------]1 r / ----------------- REVIEWEDBY--------------------------- ----`-------=--- DATE------ /L----------------------------=-------- -- - ---- - ------------ --------------- -- BUILDiNG PERMIT ISSUED---------- ---- ---------------------I and/or recommendations._____. _ _-- - -- ---- - ------------ ------------------------------ Fo ------------------------------- --- -- ------ ----- -------------------- ----------- ---------------------------------------------------- - --- --------- ------------• - -- -- - ---- - - ----- 37--------------- --------- Date------- ----- ----------- FINAL INSPECTION BY:- -- ----• -- ----- ------------- - - SAN'JOAQUIN LOCAL HEALTH,DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California { Stockton. California Lodi, California t - ES-4-2M RLisoci 1-57 VRCO. _ __