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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 104� 00(_-100 -2-1 Applica4-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. 549. JOB ADDRESS AND Phone------------------------------------ Owner's Name___-40, _:� '_ _'_ ... --.J— - -------- --- ---!t-�------------------------------- -------------------------------------------------------------------------------------- Address-------d.4' ---------- if. -----i ------------------------------------------- Contractor's Name--__ _ - -- ------ --- - ----- Motel [3 Other F installation will serve: Residence d_1NMtment House [I Commercial El Trailer Court El A-J I;r4 Number of living units: Number of bedrooms .3--- Number of baths ---I---- Lot size --- Water Supply: Public' system ❑El. Community system El Private @4.Depth to Water Table 44 ft. y Loam Ej Clay [] Adobe[] Hardpan E] Character of soil to a depth of 3 feet' Sand E] Gravel El Sandy Loam [� a� Previous Application Made: Yes El No ew Construction. Yes 9-14"Q- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F ------ -------_.M-ateria�---------------------- D STn-t'-Ta n Distance fr6rh'nearesf-WeO ep No. of compartmerifs._ T-- Size_ -------0------Liquid clepth !�J7------------ -Capacity___$---- ------- nearest well-TIP..-L-Distance'from foundation--__0--e---.Distance to nearest lot line----I---------- Disposal Field: Distance from each line-------10_0 ' -...,-.Width of french-- ------------------- gj,— Number of lines_-_____--I?... -------------- --Length of --jz;i ormaterial__---�4;1...........Total length------/.,Pp ------------------- Type I filter material----11---------- ----Depth of filter Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Seepage Pit: Number of pits-------------------- -Lining material------------------------Size: Diameter---------- -----------Depth--------------------------------- Cesspool: Distance from nearest well-------I ....Distance from foundation______________..._ Lining material-..._________-__.___.__------ ❑ - -- Size: Diameter----- --------------------------------Depth-------------------------- ------_ -----_--------Liquid Capacity._--------_- -------------_-.gals Distance from nearest well-----------------_------- ----------- ---------Distance from nearest building----------- ------------------------------ 7 Privy: El Distance to nearest lot line... ----------------------------- --------------------------------------------------------------------------- -------------------- Remodeling and/or repairing (describe):--------- --------------- ----------------------------- --------- ------------------------------ I------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- --------------------------------------------------------------------------------------------------------------I------------I----------I---------------------------------------------------------------- ------------------------------------------------------------------------------ ----- --- ------ --- --- - -------- ---I her-e-6-y_.certify-- A-a-t__I__have prepared this-application and that thework will be done in accordance with San Joaquin County ordinances, S ate laws, and rules and regulations of the San Joaquin Local Health District. 0001 40. <14 --------------- ------------- ------------------pwner-end/-G& Contractor] -------------- --- ---- --------- (Signed)----- -------(Title)------------------------------------------------------- -- ----- ------- ------------ ----------- ---- side). By:- of -V -fc-2---b— (Plot plan, owin4lime- -16t, location of system-in w6lls, uildinis7e . an e pliced on reverse FOR DEPARTMENT USE ONLY DATE--------------- APPLICATION ACCEPTED BY----------------- ------- DATE------------- -!-- --- REVIEWEDBY-------------------------- ---------------------------- ------------------- --- ------------ DATE------------------------ ----------------------------------- BUILDIN(�,-%PERMIT ISSUED---------------------------------- _:----------------- ------------------ yll� ----------- Alterations and/or.recommendations ........ ...2,------ ---------- -------- ------------------------------- ----------------------------- ----------------------- -------------------- ------------- ------------- -------------------------------------------------------------------------------------- -_----------------------- ----------------------------------------------------- ------------------------------ ----------------------- --------------------------I------------------------------------------ -------- ------------------ ------------------ --------------I ----------------------- -------------------------- ----------------------------------1-------------------------------------------- -------- ------------------------------ ------------- ----------------- --------- - -------------- ----------------------- --------I-------------- ------------------------i------6---- NAL INSPECTION V--- ------------------- Date----- --------------- SAN ate----- ---------------SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South Amaritan Street Stockton, California Lodi, California Manteca.I California Tracy, California -" ,2m 145A46 ATWC00 12-S4