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yp-=ay-- APPLICATIQIs; FUR SANITATION PERMIT Permit No. ._-........... -------------------------------------------------------- (Complete in Duplicate) � --------------------------------------------------------- This Permit Ex ires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with Co rdinance No. 549. 1 JOB ADDRESS AND LOCQATIONf t'Q ZgO Owner's Name------ Address. �+ �• J ' '" ---•---•------ ------------ -------------------------------- -- --- Phone....&a_.�..C.78* ,�- on#recfor's Neme. ..... .......... t'G ..r_. H ----------------------- --------------------------------- ----------- ---Motel one---•--•---•----•----•"---------.... Installation will serve: Residence X% Apartment ouse ❑ Commercials. .Trailer Court 4, ❑ "Other ❑ Number of living units: ----/-- Number of bedrooms ___ � �. Number�of bathsl..__.__ Lot size ----- Water Supply: Public system y ❑ Community system ❑ Private X Depth To Wafer Table -------- ft. Character of soil to a depth of 3�feet: Spnd rGrV`Nlo ❑ Sandy Loam Clay Loam Clay Cg3, .cZ .749 �� I Y ❑ Y ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---.___�_ ` New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No J 0 TYPE OF INSTALLATION AND SPECIFICATIO: ' yy (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�Ink: Distance from nearest wellt` E 7 _Distance from"foundation----� ""-,.Material_ No. of compartments_.'- -_ -- --- _ 1 't f _X-f-- Liquid depth-----''��. Ca aci P-Z LZ ��.: P ty...l_ Disposal Field: Distance from nearest well . - ' Distance from foundat'on__..t< '•..,"-Distance to nearest lot hne__ 1?�_-._ 7 Number of lines--------••""- - .-"__--- Length:.of each Gne . _ Width of trench.--"_-- —. Type of filter material P -• ----•----------- _14V�--�_" ,�De th of filter ma#erial_ _ � (4 Total length 1 � - Seepage Pit: Distance to nearest well---------------_------Distance from foundation___-•--___....____ . Distance to nearest lot line_________________ ❑ Number of pits-----•----------------Lining mate rial_-.-------.--_------_--Size: Diameter Depth ---------_----------••- Cesspool: Distance from nearest well------------------Distance from-foundation-------------------- Lining material--,Size: Diameter ;� •#:-Depth. "11 Liquid'Capacify-.q P gals. Privy: Distance from nearest well-_` `-------------------------- �-' Distance from nearest building ❑ + Dist d't n - .,..I ` g -----.------ �e to neares ----------------------------- } � ` r �r Remodeling and/or repairing (desZ e]: a �� . "" ... _ ---- --- - r)n I hereby certify t } I have prep -----•----------- ------ r ared thi rpIricafion anJ t�A At w3A will be done in accordance with an Joaquin County - ordinances, St laws, and rules end regulations of the San Joagttrh Local Health District. (Signed).___ -- ------ ----- ________________(Owner and/or Contractor) By:---------------------------------------- ----- - ----------- 71 - �= = '°{Ti#le� ------------------------------ -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- v -- -;,�_ �, REVIEWED BY. - -----------•---------------------- ---- DATE------- �"-. U_"_�a - ........................................ DATE.-----------------•- •---- BUILDING PERMISUED_-•------------------""-•- °.' Alteration andor recommendations: --------�r•-----------------------•--------------------------------- DATE------------------------------------------------------------- s d' ons:__.__.. ______.-_-"""-_.",_.-"""_--".-- -.� - _4F.- .. ....... - ----- --- 01 ---------------- -- . ` FINAL INSPECTION BY:_-..------ �{ ----- --:�.�----•-----•-• --------------- Date---- ------------ SAN JOAQUIN LOCAL HiALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street Stockton,California405 West 9Th Street Lodi,California Manteca,Caiifarnla E5 9 REVISED 8-59 2M 5-62 ATLAS Tracy,California