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FOR OFFICE USE: -------- --e I APPLICATION FOR SANITATION PERMIT Permit No ...... (�•o`�... ----- , (Complete in Duplicate) Date Issued .__. ---:-__-v " ------------------- ---------------- This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance; with Coun Ordinance No. 549. ------- JOB ADDRESS AND CATION__... f!� Phone----_----------•-----------•-•--- —Z I V Owners Name___________ ___ -- ---------••-------- _ C _______ Address--------------- -• ---• � -- --------•-------•---------------•------------------------------------------------------•-•------•----•--••---•-.._....---....:---•-----•-•--- ;�- --•------------------- Phone -----------•--.--•----•----- Contractor's Name...............•-----------•-.- -------------•---------------------------- -------•r Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: .-` ___ Number of bedrooms .-_2 Number of baths __�_.-- Lot sire ..-------_� / " """"""" ' Depth To Water Table _�9ft. Water Supply: Public system Community system ❑ Private ❑ P t Cia Loam Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Y ❑ ew Construction: Yes `� Yes ❑�o ❑ FHA/VA: No �; Previous Application Made: (If yes,date ---- --------------`-) No �N R TYPE OF INSTALLATION,AND SPECIFICATIONS: \ (Nods is tank or cesspool p�rmit+ed if public sewer is available within 204 feet.) Se ank Distance from nearest well________________ Distance from foundation #h_.Material-------------------------------------------------- Distance _-_--- Opacity_.-___-_____._----.---- - ----------------Size--------------------------------Liquid ep. Na. of compartTnents______. .: Dis al Fi 4 Distance from nlearest well------------- Donath ofreach i ne a#ion:---.--:---=----W dthtof trench to nearest lot line:_--------------- Number of lines-------------------------- g Type of filter rr'ateriai------------------------•Depth of filter material.------.•_---�-------Total length_.------••------- - 61 1 .__Distan m foundation� Lt_..------ Dista4 a to nearest lot li� -•---- I Seepage Pit: Distance to neares# well, 40 - CLQ $ize: Diameter__c�. 3------------ .4 ----- Lq' Number of pits-----4-------------Lining materia i_.--- -- als. Cesspool: Distance from (nearest well-----------------Distance from foundation--------------- Lining material ---------------- - I ❑ Size: Diameter----- -------- ------ ------ -------Depth--------------------------------------------------- 0 --------------------------•------------- ------ --- q I Distance from nearest building------------------------------------------ Privy: Distance from nearest well---------------"--" ------------. ------ -- ❑ Distance to nearest lot ine--_--------------- ----- Remodeling and/or repairing (describe):------------------------------------------------------------------------- ------------- ---------------------------------------------------I• ------ -------------------------------- ------- -------•------•---•-------"------------------- -••----• -----•-----•---=---- ----------------•----- -•--- ' hereby certify that I hav* prepared th' app ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regu ons f the San oaquin Local Health District. I (Owner and/or Contractor)(Signed). P -- = --- BY (Piot plan, showing size of cation of system in elation to wells, buildings, etc., can be laced on reverse sl e. FOR DEPARTMENT USE ONLY r D APPLICATION ACCEPTED BY-......,�JJ------- ------ -- -- ---------------------------------------- ATE--�-�-.._�------•---- DATE-------------------- ------ REVIEWED BY------ ------------------------------------ - ------------ DATE ----------------------------- BUILDING PERMIT ISSUED--------=---------------•---------------------------------- --------------------------------------- ----•-------•-------••---------_-----•-----•-------------- Alterations and/or recommendafiions-------------------------------------------------------------------------------------------------- --------------___________________ -----------•----•--•--•------- - ----- - --------- ---- ------- ----- ------------- --- I • Date---��-------------- FINAL INSPECTION BY:---.--'�---- _- -------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT i 24 Sycamore Street racy,205 West 9th Street 130 South American street Manteca, Welt Gale Srreet TCalifornia Manteca,California - ' Stockton,California Lodi,California ES 9 REVISED 8-59 2M 5-62 ATLAS