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No. ---------- APPLICATION FOR SANITATION PERMIT Permi (Complete in Duplicate) Date sued --- and install the work herein described. lic made to the San Joaquin Local Health District for a permit to construct Application is hereby This application is made in compliance with County Ordinance N . ___ -------- ------------- ------- -- ---- JOB ADDRESS AND CATION------- -- --- -------- - --------------- - ------ -----FjTbne-------------------- -- -------- Owner'sName-j -- ----- --- --- - --- ------ --- --- --------- ----- V�...... Address Contractor's N me---------- ------ --------------------------- ler Court 0 Motel 11 Other ❑ Installation will serve: Residence Apartment House E3 Commercial E] Trai rooms Number of baths --/---- Lot size ------------------------- Number of living units: -)---- Number of bed ble4jb ft. Water Supply- Public, system Community system 'El Private [I Depth to Wafer Ta • Gravel E] Sandy Loam El Clay ❑Loam E3 Clay Ej Aclob,�� Hardpan.C] Character of soil to a depth of 3 feet: Sand F1 No 0 Previous Application Made: Yes [-] No,JN� New Construction: Yes TYPE OF INSTALLATION,AND SPECIFICATIONS- 200 feet. or cesspool P public sewer is available within ' '� I (No septic tank permitted if publi -4 Malerias--- ----------- Septic Tank- Distance from nearest well �g,, ----A-Distance from foundati Size Capacify---�-�-V--------- depi-h- No. of compartments----- 7---------- P� reach --------------------Distance to nearest lot line--__--_-_---- Disposal Field: Distance from nearest well--------- -------Distance -Wiclfh of french 0 Number of lines__ -------------------------------Length of each line---------------------------- Type of filter material__-----------------------Depth of filter material------------------/---Total length----------------------------- ----Distance to nearest lot line --------- f orn tooclafion---/ #,- Distance to nearest Distance �; - --/)---- ----------------- See a e Pit Number of pits-_-__J-------------Lining Size: D!a meter- --------- x Cesspool: Distance from nearest well--------------- Distance from foundaiion--------------------Lining material------------------------------------ Size. Diameter--------------------- ------------ ---Dept h----------------------------------------------------Uquid Capacity----------------------------9 Q�l s F1 tance from nearest building----------------------------------------- Dis glis Privy: Distance from nearest well_________________---_____--_--_ I ----------------------------------------❑ - Distance to nearest lot line----- ------ -------------------------------------------------------------------------------------- ---- repairing (describe):------------- -------0-1--,-- --P 1P Remodeling and/or //�4 ----------------------- ---------------------------------------------------------------- ------------------------------------------------- --------------------I---------------------- --------------------------------�u------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------11--------------------------- -------------------------------- that the work will be done in accordance with San Joaquin.County `Y) or I hereby certify that I have prepared this application and -4 ordinances. State t-w-t� and sand regulations of the San Joaqui'n Local Health District. , t — Joaquin idw -----------(Owner and/or C ttracto,r) ---------- A --------- i ----- -------------------------------------- (Signed)-------------- ---- --- 14 -------------------- By:----------- ------- V --------- - d on reverse side). 11 buildings, efc., can be place -----------(r , _cation ys I elation to wells, b (Plot plan, showing size of lot of/s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY, ------------------------ ------------------------------------------------------- DATE--S-—---------------------------------------------- DATE----�—V.... 9i--1-- ----------------------------------------- ----------------------------------- REVIEWED BY------------------------- -------- DATE----------;e-------------------------------------------- BUILDING PERMIT ISSUED ---------------- ----------------------------------------------------------------------------------- -------------------- ---------------------- Alterations and/or recommendations:__--------------------------------------------------------------------------------------- ------------------------------------------- ------------------------------------------------- --------------------------------------------- --------------------------------------------------------- ---------------------------- ----------------------------I--------------------------------...... ------------------------------------------------I------------------------------- ------------------------------------------------------------------------ ------------------------------------------------------------------ -------------------------------------------------------------------------------- --------I-------------------------------------------------------------------------------------------------------- -------------------------- ------------------------- --------------------- ----------- ------------------------------------------------ ----------------I--------------I/------------ -------------------------------------- FINAL INSPECTION BY:------ -——-------------- ------------- Date------- (O�Z ---� SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 130 South American Street 300 West Oak Street 132 sycamore Street Tracy, California Stockton, California. Lodi, California Manteca, California /4-2M B-51 Revised W-2100