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FOR OFFICE USE: ht. APPLICATION FOR SANITATION PERMIT Permit No- -- ------------- --------------- - r . a - Duplicate) Date Issued ._�_�L--_------ --------------------------� c----- ----- Com fete in -----__.___ 'This Permit Expires 1 Year From Date Issued Applicafiion n is hereby made to the San Joaquin Local Health District or a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No J' /.dl' 0i--------------------- ---- -- ------..- JOB ADDRESS AN ATION...�o__157-2_- �� . � __...� �1�`J -----------•-------- ------------ ----------•-------------•----------------- Phone._ .. .. Owner's Name_________ _ ______ Address------••------------ zi--.`-_ �� -----------•....... `�— J �[�!Y1 G ----------•-- Phone. �f �/ Contractor's Name__ �tC.- t Motel Other Installation will serve: Residence 'Apartment House ❑ Commercial Trailer Court. ❑ ❑ ❑ ❑ �'`---�-------L.. . Number of living units: ---!.-. Number of bedrooms _I Number of baths __�-_ Lot size ._.__ Water .$upply: .Public system $_Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to atdepth of 3 feet: Sand ❑ Gravel•❑ 'Sandy-.Loam ❑ Clay Loam ❑ Clay ❑ Adobe` Hardpan ❑ Previous Application Made: (If yes,date---------- -------) �,No 1� New Construction: Yes ❑ No ❑ FHA/VA- Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + No septic tank or cesspool permitted if public fewer is available within 200 feet.} cDistance from nearest well-----------------.Distance from foundation__.__..______._._-_.Material_.____.___:_____---___.__.-.-.-------.------__--• - ---Liquid depth--------------------------Ca Capacity -- ! No. of compartments--------• ---------------Size--------•------------- f p tY------=--------F- Distance from nearest well._ Distance from foundation.-_Art. --Distance to nearest lot line______... p , .� Number of lines----/____ ____._ _ Length of each linec�_�J ._______ Width of trench___ _ _________-------________ Type of filter material_ _ --_-Depth of filter 'material___1_ ��____.._-_.Total length__._.____G�,�-'-----•--•-------� i Seepage Pit: Distance to near_est well..l�CQ 1�SZ1_D•iistance from fo ndation---__t.S'_-.___.Distance to nearest lot line_-----. .._____ Number;of pits------1--------------Lining materials-o .-Size: Diameter._�o3-----------Depth-----CQf•l Cesspool: Distance from nearest well-----------------Distance from foundation-____ __ ----------Lining materia-------- --------.---___-_---. ❑ Size: Diameter------------------------------------- Depth------------r---------------------------------------Liquid Capacity----•-----------------------gals. 1 -_Distance from nearest building Distance,•to nearest lot line----------- ----- ------ ----------•-•--------•--------------------•---------------•---- ! ❑ 5 t Remodeling and/or repairing (describe)------------------ - - -- ----- - ----- P . ____------_---------------------------------------------------------_------------ ______ _ ____ -------- _ ___------------------------------------------------------------------------- -----------------•----------------------•'------------------.-----_ ---- �_ w.. --.-_-----------------------------------------.__.--__________.__.___________.._________ .__......_.------ _----________.- _______ __ I here;y,&ertify that I have prepared this application and that +he work will a done in accordance with San Joaquin County ordinances, -State laws, arules and regulations of the San Joaquin Local Health District. dh�i�� pry �.. ._ fl�--------------------------------------------------------- - --- --------------------.-.------- Contract (Signed) -- --- --------------- or Plot Ian, 4.4l�dll�c.09- if ;", (Title}-- ( p showing size of lot, location of system"in relation +o well buildings, a ., can be placed on reverse side). $ k FOR DEPARTMENT USE ONLY I � APPLICATION<. ACCEPTED gY--- -- -- -------- - -- ----------------- -------------- DATE--------�-J-f --r----------------------------- - - - - - -- ------ REVIEWEDBY. "'� DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------- ------ DATE--------•----------•----•-------------------------- ----- Alterafio s andior recom ends -ons, ( El -------------- - ----- Grt�X 4ZW -----••-------- ----------- ----------------------------------------------------------------------------- __. --- -- -----------•- - -- - off- - ..__ FINALINSPECTION BY------ --- ----------- - ----- ------------------- Date----------- 0-------------- ----------------------- s ,{- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street ! Stockton,CaliforniaLodi,Califorpia Manteca,California Tracy,California s k4 l-6-9 i3EVIfiEO 9-59 r•r-co-2-6.60 - > `t.i Z