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APPLICATION FOR SANITATION PERMIT Permit Na. Date Issued ---•�-�-��c�-w V (Complete in Duplicate) Applica}ion is hereby made to the San1J Joaquin Local HealthdDiNric for a permit to construct and install the work herein described. This application is made in compliance w Y - , JOS ADDRESS AN OC TION _.- /!- ------------- Phone--------------------------------- ------------- Name--------- -- - - f -•• ........................ ,�r. — Address-.. -- .. . - --------- Phone f ---------------- --------- ---- Contractor's Name Motel ❑ Other ❑ Installation will serve: o Residence 0- Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of living units: ----- Number of bedrooms _/--- Number of baths .I---- Lot size ___ -.- °R�--r--- Private Depth to Water Table J-eft. Water Supply: Public system ❑ Co mmunity system ❑ -- Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: Yes El No � New Construction: Yes,®_ No [3 TYPE OF INSTALLATION AND SPkIFICATIONS: . (No septic tank or cesspool permitted if publicseweris available within 200 feet.) ► -Material --Lam-----Cf--.�`s Septic Tank: Distance from nearest well ;u-------Distance from foundation.-fly.------_-- . Ca acit f� No. of compartments..---.".r `- 5ize_---�� --?� -��Liquid depth---. �p-- P Y f Distance to nearest lot line-"- Disposal Field: Distance from nearest well..:174-------Distance from foundation-_ 4r Width of trench. "- ?-Sy jr------- -Leng6 of each line--_-"-.. . .---.-... Number of lines-=----------�- -j---;j- ---- g f r Total len th_.."r-f ------------- _122- ---------•--•-• Type of filter material----/c --- Depth of filter material-_-,. -_ _ 9 �' Distance from foundation_--.-/�"a__.-__.Distance to nearest lot line-_-� -r-- x Seepage Pit: Distance to nearest well - Diameter----�_�------Depth-_�-sf'---------------- Nu ----- o\ Number of its:_..--- "Lining materia;_ Lining «<VVV Distance from nearest well------_------"_-Distance from foundation-------------------- material---__.---"_ --_---all Cesspool: -------Liquid Capacity gals. ❑ Size: Diameter._±----------------=-------- Depth Distance' rom ;earest wel;_---___.- Distance from nearest building -I__.."-------------------- Privy: --- "Distance to nearest lot line-----------•----�------- - ---------------------------- Remodeling and/or repairing (descnl7e):_--"-- -------------"--- .-- -- --- - --------------------- -- ------•----------•--- ---------------------------- Sa ------qui ! hereby certify that I have prepareduthis -application lli the San Joaquin Local Health will he done in accordance wi#h San Joaquin County ordinances, State s, a rules. and eq (Owner and/or Contractor) ----�� ------------------------------------------- (Signed) - ----------------- ------- i _ ---ITitl ---- -----x------- By: - (Plot plan, showing size of lot, location of sys#em in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY ------------ DATE-----------; APPLICATION ACCEPTED BY--- i------- ------------- - ------------------ DATE---------- I--------------- REVIEWED BY------------------------- :#----------- ----- DATE.--------------- - � - -- ----- ------- -- --------------------- BUILDING PERMIT ISSUED--------== Alterations and/or recommendations: ------------=- .-- ---_--_--------•- ------- ---------------- ----- ------------ ---- - ---•--- ------ ---- ------------------- ----------------- J - - - -------•-------------------•------- FINAL INSPECTION BY:------ -- � Date ----- ------------------------ --- -- - ----------- -- - --- .--!"-__-- ------SAN JOAQUIN LOCAL HEALTH DISTRICT rSycamore ycamore Stree+ 844 North "G" Street 300 West Oak Street Tracy, California i30 South American S+rest Manteca, California Stock+on, California Lodi, California . E'-' 9-2M 145446 TWODo ,zea _