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F R OFFICE7USE: I / / 71 V-�-------- � ----- Permit No.APPLICATION FOR SANITATION PERMIT�- �, - --------- (Complete in Duplicate) Date Issued------ -------- - - -- ------ This Permit Ex ires 1 Year From Date Issued -------- --- Application is her made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No. 549., J JOB ADDRESS AND LOCATION---- - .---- ,.� ' - --------------------- Phone ► -- - `� Owners Name . 1,w r --------------------------- --- ----------- Address. one ------------------------------ -- ---------- -- _ ------------------------ Contractor's Name___-____-•___. _ - - - - Motel ❑ Other ❑ Installation will serve: Residence [ partment House ❑ C6mmercial ElTrailer Court [I a - ' ---------•-------- Number of living units: ----t NNu''m��ber of bedrooms _.moi.- Number of baths ------ Lot size _-___�_�_-.-- i/�-.1 Water Supply: Public system ©-"'I--- i Sys tem Private ❑ Depth to Water Table -------- ft. PP Y� tY ❑ Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Ye o ❑_ Previous Application Made: (if yes date.._.___..,__--_--} No ��' Construction: Yes ❑ No •' FHA/VA ❑ Prev pp . . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available_with n_Z00 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation':-_-____�_~.-_.".Material_------------------------------------------ r . -�_ �/� No. of compartments Size.- --------- quid depth Capacity Dis osal Fieri: Distance from nearest well.------__________Distance from fou ndation--------..-_____-._.Distance to nearest lot line______________.- - ---- -�- �----Width of trench------------------------------------ -of p .. �j�Number of lines----------------------- Length each ine____- ------- Type of filter material-------------------------Depth.of filter mate tion length__._-___.------------- ' I f r Distance m foundation-___ s _..------Distance to nearest lot line__It_�'---------- i Seepage P�it'i Distance to nearest ell--------•:T7�- �� : ± Size: Diameter, '---��--------Depth--- -1- -'r'` r /umber of pits materia _ ��// G�efsool: / Distance from nearest well-_______.____._Distance from foundation____________________Lining materia_____--.-_____.____-_---------- ---- Size: Diameter------------------------- Depth Liquid Capacity gals' 10 El Distance from nearest well---------------------- -------`--s -._,D.istance..from�earest building-------------------------- Privy: ... ----------------- -------- ---- ❑ Distance to nearest lot line----------------------------- Remodeling ----------------- Y F= u . ------ ------ ---------- I `` ---------•- Remodeling and/or repairing (describe)______________ ---51- --•---------------------------------------------------•-- --------------------------------- -•---•---------------------------------------------------------------------------------------- --s------ 1s ---------------- .---- I hereby certify that I have prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances. State laws, and-lull and regulatiJn f thg San Joaquin Local Health District. ned r ' [______________________________ 0-- - ----------------- By: _ _(Owner and/or Contractor) / i --A- rr - - --- ,r -------------- (Title) _ �` (Plot plan, showing size of lot, ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY er -- ---- - ---- ------ ----- --- DATE---7//--3 --—V- --- APPLICATION ACCEPTED BY_._ ._._____ ___._-_•-.T�-; ---•- DATE------ -------- -------- •--------------- REVIEWEDBY--------------------------------------------- --------------------------------------------- --- --------------- DAT ------------------------------------------------------------- BUILDING PERMIT ISSUED ----------------- - // L Alterations and/or recommendations:_ - �7/r y L ----------•---•-------------------------- _ _ -----..-'-.___- / --- --------- -------- Date_ --7/- /--� ---y+ - ------- -------- FINAL INSPECTION BY:.-.f1--r- ._ SAN JOAQU•IN LOCAL HEALTH DISTRICT 1601 E.Ha�eHon Ave. west Oak Street 124 Sycamore Street 205 West 9th Street mante-co,California Tracy,California Stockton,California Lodi,California 9 ES 9 REVI5EO 6-59 3M 3-'63 F.P.Ca.